Current Practices for Evaluation of Resonance Disorders in North America

ABSTRACT

Improving treatment outcomes for people with resonance problems (due to velopharyngeal disorders) is a priority for many speech-language pathologists (SLPs), but there exists a limited understanding of the practices SLPs are using to assess and monitor therapeutic effects in this population. The current study was designed to answer the following questions: (1) What are current clinical practices versus best practices for assessing resonance disorders, tracking therapeutic effects, and determining discharge criteria? (2) What assessment practices would SLPs prefer to use with clients who have resonance disorders? (3) What are barriers to SLPs' use of best practices? and (4) What effects do SLP demographics have on clinical practices? Thirty‐eight SLPs, specializing in the treatment of resonance disorders, participated in the study. Responses were compared with best practice recommendations derived from the literature. Most clinicians were using low‐tech assessment tools, often because they lacked access to high‐tech tools. Demographics and training did not affect clinical assessment practices. There is a need to increase the availability of high‐tech assessment tools to SLPs practicing in the area of resonance disorders, as consistent use of sophisticated assessment devices would exemplify contemporary thinking about the transfer of knowledge to practice in this area.

KEYWORDS

Velopharyngeal disorder - velopharyngeal impairment - assessment - best practices

REFERENCES

• 1 Lallh A K, Rochet A P. The effect of information on listeners' attitudes toward speakers with voice or resonance disorders.  J Speech Lang Hear Res. 2000;  43 (3) 782-795
• 2 Marsh J L. Management of velopharyngeal dysfunction: differential diagnosis for differential management.  J Craniofac Surg. 2003;  14 (5) 621-628 discussion 629
• 3 Rieger J M, Dickson N, Lemire R et al.. Social perceptions of speech in individuals with oropharyngeal reconstruction.  J Psychosoc Oncol. 2006;  24 (4) 33-51
• 4 Witt P D, Miller D C, Marsh J L, Muntz H R, Grames L M, Pilgram T K. Perception of postpalatoplasty speech differences in school-age children by parents, teachers, and professional speech pathologists.  Plast Reconstr Surg. 1997;  100 (7) 1655-1663
• 5 American Speech-Language-Hearing Association .Preferred practice patterns for the profession of speech-language pathology [Preferred Practice Patterns]. 2004. Available at: http://www.asha.org/policy Accessed May 7, 2010
• 6 Canadian Association of Speech-Language Pathologists and Audiologists .Assessing and Certifying Clinical Competency: Foundations of Clinical Practice for Audiology and Speech-Language Pathology. Ottawa, ON: Canadian Association of Speech-Language Pathologists and Audiologists; 2004
• 7 Kummer A. Cleft Palate and Craniofacial Anomalies: Effects on Speech and Resonance. San Diego, CA: Singular Thomson Learning; 2001
• 8 McQueen K, Dennis C L. Registered Nurses Association of Ontario . Development of a postpartum depression best practice guideline: a review of the systematic process.  J Nurs Care Qual. 2007;  22 (3) 199-204
• 9 Lohmander A, Olsson M. Methodology for perceptual assessment of speech in patients with cleft palate: a critical review of the literature.  Cleft Palate Craniofac J. 2004;  41 (1) 64-70
• 10 Patton M Q. Qualitative Research and Evaluation Methods. 3rd ed. Thousand Oaks, CA: Sage Publishing; 2002
• 11 Dalston R M, Neiman G S, Gonzalez-Landa G. Nasometric sensitivity and specificity: a cross-dialect and cross-culture study.  Cleft Palate Craniofac J. 1993;  30 (3) 285-291
• 12 Seaver E J, Dalston R M, Leeper H A, Adams L E. A study of nasometric values for normal nasal resonance.  J Speech Hear Res. 1991;  34 (4) 715-721
• 13 MacKay I R, Kummer A W. Simplified Nasometric Assessment Procedures. Lincoln Park, NJ: Kay Elemetrics; 1994
• 14 Bzoch K R. Measurement and assessment of categorical aspects of cleft palate speech. In: Bzoch K R, ed. Communicative Disorders Related to Cleft Lip and Palate. Boston, MA: Little Brown; 1979: 161-191
• 15 Templin M, Darley F. The Templin-Darley Tests of Articulation. Iowa City, IA: Bureau of Educational Research, University of Iowa; 1960
• 16 Fletcher S. Diagnosing Speech Disorders from Cleft Palate. New York, NY: Grune & Stratton; 1978
• 17 Warren D W, Dubois A B. A pressure-flow technique for measuring velopharyngeal orifice area during continuous speech.  Cleft Palate J. 1964;  1 (1) 52-71
• 18 Campbell T F, Linville R N, Yates C. Aerodynamic assessment of speech using the PERCI-PC: evaluation and reliability.  Plast Reconstr Surg. 1991;  87 (2) 365-370
• 19 Warren D W. Perci: a method for rating palatal efficiency.  Cleft Palate J. 1979;  16 (3) 279-285
• 20 Dalston R M, Warren D W, Dalston E T. The identification of nasal obstruction through clinical judgments of hyponasality and nasometric assessment of speech acoustics.  Am J Orthod Dentofacial Orthop. 1991;  100 (1) 59-65
• 21 Seagle M B, Mazaheri M K, Dixon-Wood V L, Williams W N. Evaluation and treatment of velopharyngeal insufficiency: the University of Florida experience.  Ann Plast Surg. 2002;  48 (5) 464-470
• 22 Pigott R W. An analysis of the strengths and weaknesses of endoscopic and radiological investigations of velopharyngeal incompetence based on a 20 year experience of simultaneous recording.  Br J Plast Surg. 2002;  55 (1) 32-34
• 23 Karnell M, Seaver E. In: Bardach J, Morris H L, eds. Multidisciplinary Management of Cleft Lip and Palate. Philadelphia, PA: WB Saunders; 1990: 776-786
• 24 Rudnick E F, Sie K C. Velopharyngeal insufficiency: current concepts in diagnosis and management.  Curr Opin Otolaryngol Head Neck Surg. 2008;  16 (6) 530-535
• 25 Henningsson G, Isberg A. Comparison between multiview videofluoroscopy and nasendoscopy of velopharyngeal movements.  Cleft Palate Craniofac J. 1991;  28 (4) 413-417 discussion 417-418
• 26 Skolnick M L. Videofluoroscopic examination of the velopharyngeal portal during phonation in lateral and base projections—a new technique for studying the mechanics of closure.  Cleft Palate J. 1970;  7 803-816
• 27 Canadian Association of Speech-Language Pathologists and Audiologists .CASLPA Position Paper on Dysphagia in Adults. Ottawa, ON: Canadian Association of Speech-Language Pathologists and Audiologists; 2007
• 28 Coffey J P, Hamilton D, Fitzsimons M, Freyne P J. Image processing of videofluoroscopy of patients with velopharyngeal insufficiency and hypernasal speech.  Clin Radiol. 1993;  48 (4) 260-263
• 29 Frosh A C, Jayaraj S, Porter G, Almeyda J. Is local anaesthesia actually beneficial in flexible fibreoptic nasendoscopy?.  Clin Otolaryngol Allied Sci. 1998;  23 (3) 259-262
• 30 Ramamurthy L, Wyatt R A, Whitby D, Martin D, Davenport P. The evaluation of velopharyngeal function using flexible nasendoscopy.  J Laryngol Otol. 1997;  111 (8) 739-745
• 31 Lennox P, Hern J, Birchall M, Lund V. Local anaesthesia in flexible nasendoscopy. A comparison between cocaine and co-phenylcaine.  J Laryngol Otol. 1996;  110 (6) 540-542
• 32 Georgalas C, Sandhu G, Frosh A, Xenellis J. Cophenylcaine spray vs. placebo in flexible nasendoscopy: a prospective double-blind randomised controlled trial.  Int J Clin Pract. 2005;  59 (2) 130-133
• 33 Golding-Kushner K J, Argamaso R V, Cotton R T et al.. Standardization for the reporting of nasopharyngoscopy and multiview videofluoroscopy: a report from an International Working Group.  Cleft Palate J. 1990;  27 (4) 337-347 discussion 347-348
• 34 Dalston R M, Warren D W, Dalston E T. Use of nasometry as a diagnostic tool for identifying patients with velopharyngeal impairment.  Cleft Palate Craniofac J. 1991;  28 (2) 184-188 discussion 188-189
• 35 Schiavetti N, Metz D E. Evaluating Research in Communication Disorders. 5th ed. Boston, MA: Allyn and Bacon; 2005