Evaluation of cleft palate speech

Avaliação da nasalidade de fala na fissura labiopalatina

“…Usually instrumental evaluations are obtained from more invasive techniques which allow visualization of the structures of the velopharyngeal mechanism such as nasoendoscopy and videofluoroscopy. Instruments that provide the possibility of analyzing acoustic aspects (as nasometry) or aerodynamic aspects of speech (such as pressure-flow technique) can used only to corroborate perceptual findings, since they allow clinicians only to infer the adequacy or inadequacy of the velopharyngeal function (5,6,8,26) . As with prior literature, the variation of outcome as identified with different modalities of assessment with this study also point towards the importance of combining different methods for assessment of speech and velopharyngeal function in clinical practice.…”

“…A study with SLPs associated with cleft palate teams at North America found that 99% of the teams use the perceptual evaluation as the golden standard procedure to establish speech outcome during velopharyngeal evaluation (5) . Considering that the symptoms of VPD are perceptual in nature, auditory-perceptual judgments are selected as gold standard for evaluation (6,7) and should be done by trained listeners (8,9) . The identification of presence of hypernasality by craniofacial teams is often accomplished through auditory-perceptual assessment using binary scales (abnormal vs normal) or using scales with equal intervals such as the 4 point scale where 1 = normal, 2 = mild, 3 = moderate and 4 = severe hypernasality, for example.…”

Concordância entre os testes perceptivos e a videofluoroscopia no diagnóstico da disfunção velofaríngea

“…Instrumental methods such as videofluoroscopy and nasoendoscopy can provide information on the functional anatomy of the VPM, as well as nasometry and the pressure-flow technique can respectively measure the acoustic and aerodynamic parameters of the velopharyngeal function (4) . They may also provide the perceptual critical finding trial, enable the diagnosis of the velopharyngeal function in cases where the clinical diagnosis by itself was not possible, and also determine the effectiveness of the proposed treatment (5)(6)(7)(8)(9) . Among the various methods for perceptual evaluation described in the literature, few of them provide the differential diagnosis of VPD, as the Tests of Hypernasality (THYPER) and Nasal Air Emission (TNAE) (5)(6)(7)(8)(9)(10) , with the aim of assisting assessment of velopharyngeal function and dysfunction.…”

Fala em indivíduos com fissura labiopalatina após a palatoplastia primária pelas técnicas de Furlow e von Langenbeck

“…Apesar de a avaliação perceptivo-auditiva ser considerada padrão ouro para avaliar as alterações de fala relacionadas à função velofaríngea e à fissura palatina MOLLER, 2000;GUYETTE, 2004;SELL, 2005;KUEHN, 2007;KUMMER, 2014) e ser considerada como o primeiro método para indicar a significância das alterações de fala relacionadas à disfunção velofaríngea, sendo portanto, indispensável para o diagnóstico e para a definição do tratamento da disfunção velofaríngea CIOCCA, 2009;GENARO;TRINDADE, 2010;KIM et al, 2012;KUMMER, 2014), sua subjetividade é algo importante a ser considerado.…”

“…Sabe-se que a avaliação clínica pode sofrer influências de variáveis que podem intervir no julgamento perceptivo-auditivo, ainda que realizado por clínicos experientes (DOTEVALL et al, 2002;SOMMERLAD et al, 2002;LOHMANDER;OLSSON, 2004;GUYETTE, 2004;SELL, 2005;HENNINGSSON et al, 2008;CIOCCA, 2009;BAYLIS;MUNSON;MOLLER, 2011 SAMMAN, 2007;HENNINGSSON et al, 2008;LOHMANDER et al, 2009;OLIVEIRA, 2009;WHITAKER, 2009;NYBERG et al, 2010;KLINTÖ et al, 2011). A gravação é um recurso que se pode ter sempre à disposição, para ouvir quando e quantas vezes forem necessárias, podendo ainda ser editada e apresentada para o julgamento perceptivo-auditivo por juízes múltiplos, o que permite validar os achados clínicos obtidos durante a avaliação ao vivo.…”