Development of a Test for Velopharyngeal Competence During Speech

Abstract

As reviewed by Spriestersbach (15), the evidence now available suggests very strongly that difficulty in developing and maintaining appropriate intraoral air pressures during speech is the primary problem in speech physiology underlying speech deficits of the cleft palate population. It has been well established also that tests involving blowing activities which are designed to assess the cleft speaker's ability to generate intraoral air pres— sure have predictive value in determining whether or not that speaker has a significant velopharyngeal closure problem. As has been reviewed elsewhere by Hardy (2), the two types of such tests which have been reported most frequently utilize a wet spirometer or pressure manometer. For the former test, a subject is asked to perform a vital capacity effort through the mouth with his nostrils occluded and another with his nostrils open. For the latter test, the subject is asked to blow with maximum effort into a pressure measuring device, once with the nostrils occluded and once with the nostrils open. In both tests, if the measure for nostrils open is less than for nostrils occluded, it is assumed that air leaked through an open velopharyngeal port during the nostrils-open effort. The two measures obtained during such tests are combined into a fraction with the nostrils—open measure divided by the nostrils—occluded measure. The extent to which the resulting value1 is less than one is used as an index of velopharyngeal incompetence. Hardy (2) has pointed out certain reasons why these tests, which are obtained during a blowing activity, may not be as precise as would be desirable in predicting significant velopharyngeal incompetency of the cleft speaker. One of the reasons which he suggests for this imprecision is that there may be dissimilarity in the function of the velopharyngeal port during blowing as compared to during speech production.