The Basics of Velopharyngeal Function: A Brief Review for the Practicing Clinician

2012 ◽  
Vol 22 (2) ◽  
pp. 25-35 ◽  
Author(s):  
David L. Jones
Keyword(s):  
Cleft Palate ◽  
Gross Anatomy ◽  
Normal Anatomy ◽  
Anatomy And Physiology ◽  
Key Points ◽  
Velopharyngeal Closure ◽  
Velopharyngeal Function ◽  
And Function ◽  
Abnormal Anatomy

In this article, I will provide a basic overview of the normal anatomy and physiology of velopharyngeal function. I will address topics such as the gross anatomy of the velopharyngeal mechanism, identification of the anatomy and function of the velopharyngeal musculature, and patterns of velopharyngeal closure that occur. I will also summarize the role of the velopharyngeal mechanism as it relates to aero-acoustic aspects of speech. Although the focus of this article is normal anatomy, I do include references to abnormal anatomy (e.g. cleft palate). I will include key points to an oral mechanism examination as it pertains to velopharyngeal function.

Instrumental Assessment in Cleft Palate Care

2013 ◽  
Vol 23 (2) ◽  
pp. 49-61 ◽  
Author(s):  
Jamie Perry ◽  
Graham Schenck
Keyword(s):  
Cleft Palate ◽  
New Developments ◽  
Perceptual Evaluation ◽  
Advantages And Disadvantages ◽  
Instrumental Assessment ◽  
Speech Language Pathologist ◽  
Hypernasal Speech ◽  
Perceptual Assessment ◽  
Velopharyngeal Function ◽  
And Function

Despite advances in surgical management, it is estimated that 20–30% of children with repaired cleft palate will continue to have hypernasal speech and require a second surgery to create normal velopharyngeal function (Bricknell, McFadden, & Curran, 2002; Härtel, Karsten, & Gundlach, 1994; McWilliams, 1990). A qualitative perceptual assessment by a speech-language pathologist is considered the most important step of the evaluation for children with resonance disorders (Peterson-Falzone, Hardin-Jones, & Karnell, 2010). Direct and indirect instrumental analyses should be used to confirm or validate the perceptual evaluation of an experienced speech-language pathologist (Paal, Reulbach, Strobel-Schwarthoff, Nkenke, & Schuster, 2005). The purpose of this article is to provide an overview of current instrumental assessment methods used in cleft palate care. Both direct and indirect instrumental procedures will be reviewed with descriptions of the advantages and disadvantages of each. Lastly, new developments for evaluating velopharyngeal structures and function will be provided.

Comparing the Unaided Visual Exam to Lateral Cinefluorography in Estimating Several Parameters of Velopharyngeal Function

1984 ◽  
Vol 49 (2) ◽  
pp. 136-139 ◽  
Author(s):  
C. R. Eisenbach ◽  
W. N. Williams
Keyword(s):  
Medical Records ◽  
Velopharyngeal Insufficiency ◽  
Poor Agreement ◽  
Connected Speech ◽  
Visual Examination ◽  
Management Decisions ◽  
Form And Function ◽  
Velopharyngeal Closure ◽  
Velopharyngeal Function ◽  
And Function

Retrospectively, the medical records of patients with known velopharyngeal insufficiency (VPI) were reviewed for comments based on an unaided visual examination regarding their velopharyngeal function. These comments were compared to objective findings obtained from the cinefluorographic evaluations performed on each of the patients. A total of 68 recorded comments (47 patients) were identified and fell into four broad categories: (1) velar length, (2) depth of the nasopharynx, (3) velopharyngeal closure, and (4) velar mobility. The results revealed an agreement level of 60% between judgments made from visual examinations and cinefluorographic evaluations. This relatively poor agreement suggests that management decisions concerning VPI must include some method of objectively assessing velopharyngeal form and function during connected speech.

Anatomy and physiology of the gastrointestinal tract

2021 ◽  
pp. 1-16
Author(s):  
Jennie Burch ◽  
Brigitte Collins
Keyword(s):  
Gastrointestinal Tract ◽  
Gall Bladder ◽  
Abdominal Cavity ◽  
Structure And Function ◽  
Pelvic Cavity ◽  
Gi Tract ◽  
Waste Products ◽  
Anatomy And Physiology ◽  
And Function

The anatomy and physiology of the gastrointestinal (GI) tract chapter provides information on the parts, structure, and function of the gut. The hollow tube of the gastrointestinal tract begins at the mouth and ends at the anus. The GI tract in part lies within the abdominal cavity and the pelvic cavity. There are also the accessory organs of the liver, pancreas, and gall bladder. The nerves, hormones, secretions, and blood supply to the gut are also explored. The role of the GI tract is to ingest food and fluids. These are digested through mechanical and chemical means such as chewing. The nutrients are then absorbed, predominantly in the ileum. Waste products are finally eliminated via the anus.

How and Why Musicians Are Different from Nonmusicians: A Bibliographic Review

2011 ◽  
Vol 26 (2) ◽  
pp. 65-78 ◽  
Author(s):  
William J Dawson
Keyword(s):  
Music Perception ◽  
Age Of Onset ◽  
Musical Training ◽  
Gross Anatomy ◽  
Anatomy And Physiology ◽  
Multiple Parameters ◽  
Prolonged Duration ◽  
Neurological Differences ◽  
And Performance ◽  
And Function

Musicians differ from nonmusicians in many ways; their many special skills reflect the fact that their brains are built differently and function differently. This review of 172 references from PAMA’s bibliographic database reveals that most differences occur in the neurobiological realm, in contrast to those of gross anatomy and physiology. Gross changes occur in both cerebral and cerebellar hemispheres and in both gray and white matter. Neurophysiologic differences, measured by sophisticated imaging and electrophysiological techniques, are revealed in sound processing in general, as well as in multiple parameters of music perception, processing, and performance. Most of the neurological differences, both structural and functional, seem to be related to the early age of onset, intense degree, and prolonged duration of musical training and affect multiple, widespread areas of the brain. Training-related differences extend beyond the musical realm to speech, special senses, and general mental parameters and are seen in both instrumental and vocal musicians. A small percentage of reviewed papers demonstrated no appreciable differences between musicians and nonmusicians in a few parameters.

Structure of the Musculus Uvulae: Functional and Surgical Implications of an Anatomic Study

1997 ◽  
Vol 34 (6) ◽  
pp. 466-474 ◽  
Author(s):  
Martin H. S. Huang ◽  
S. T. Lee ◽  
K. Rajendran
Keyword(s):  
Cleft Palate ◽  
Posterior Pharyngeal Wall ◽  
Anatomic Study ◽  
Pharyngeal Wall ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Velopharyngeal Function ◽  
Intravelar Veloplasty ◽  
Anatomic Information

Objective: The role of the musculus uvulae in velopharyngeal function, its morphologic status in cleft palate, and its fate in palatoplasty procedures are subjects of controversy. The aims of this investigation were to re-examine this velar muscle to clarify its anatomic characteristics, to analyze its role in speech physiology, and to study the surgical implications of this information for cleft palate repair. Methods: Its attachments, morphology, and relations were examined in 18 fresh human adult cadavers by detailed dissection under 3.2× magnification and light microscopy. Results: The musculus uvulae was observed to be a paired midline muscle extending between the tensor aponeurosis anteriorly and the base of the uvula posteriorly along the nasal aspect of the velum. It had no attachments to the hard palate. Conclusions: These findings suggest that its action is to increase midline bulk on the nasal aspect of the velum, thus contributing to the levator eminence. It may also have an extensor effect on the nasal aspect of the velum, displacing it toward the posterior pharyngeal wall. Both of these actions would serve to maximize midline velopharyngeal contact. One clinical application of this anatomic information is that the muscle should be preserved in the dissection performed during intravelar veloplasty. Furthermore, it should be recognized that the musculus uvulae is invariably divided and reoriented incorrectly in the Furlow double opposing Z-plasty.

Laryngeal Airway Resistance in Children with Cleft Palate and Adequate Velopharyngeal Function

1995 ◽  
Vol 32 (2) ◽  
pp. 138-144 ◽  
Author(s):  
David J. Zajac
Keyword(s):  
Cleft Palate ◽  
Airway Resistance ◽  
Vowel Production ◽  
Effort Level ◽  
Syllable Repetition ◽  
Velopharyngeal Closure ◽  
Velopharyngeal Function ◽  
Laryngeal Resistance ◽  
Repetition Task ◽  
Laryngeal Airway

Laryngeal airway resistance during vowel production was determined for 10 children without cleft palate and 14 children with cleft palate and adequate velopharyngeal function. The children with cleft palate were further grouped according to either complete or incomplete velopharyngeal closure. All children performed a syllable repetition task with nostrils occluded at self-determined effort and a targeted effort typical of adult speech. Results indicated that all children exhibited significantly greater laryngeal resistance at self-determined effort. No significant differences occurred among the groups of children at either effort level. Some children with incomplete velopharyngeal closure, however, tended to exhibit relatively increased laryngeal resistance at the targeted effort level when their nostrils were unoccluded. Implications for a regulation-control model of speech production and clinical assessment are discussed.

scholarly journals Current Controversies in Diagnosis and Management of Cleft Palate and Velopharyngeal Insufficiency

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Pablo Antonio Ysunza ◽  
Gabriela M. Repetto ◽  
Maria Carmen Pamplona ◽  
Juan F. Calderon ◽  
Kenneth Shaheen ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Velopharyngeal Insufficiency ◽  
Speech Pathology ◽  
Imaging Diagnosis ◽  
Diagnosis And Management ◽  
Velopharyngeal Closure ◽  
Articulation Disorders ◽  
Recent Method ◽  
Genetics And Genomics ◽  
Velopharyngeal Function

Background. One of the most controversial topics concerning cleft palate is the diagnosis and treatment of velopharyngeal insufficiency (VPI).Objective. This paper reviews current genetic aspects of cleft palate, imaging diagnosis of VPI, the planning of operations for restoring velopharyngeal function during speech, and strategies for speech pathology treatment of articulation disorders in patients with cleft palate.Materials and Methods. An updated review of the scientific literature concerning genetic aspects of cleft palate was carried out. Current strategies for assessing and treating articulation disorders associated with cleft palate were analyzed. Imaging procedures for assessing velopharyngeal closure during speech were reviewed, including a recent method for performing intraoperative videonasopharyngoscopy.Results. Conclusions from the analysis of genetic aspects of syndromic and nonsyndromic cleft palate and their use in its diagnosis and management are presented. Strategies for classifying and treating articulation disorders in patients with cleft palate are presented. Preliminary results of the use of multiplanar videofluoroscopy as an outpatient procedure and intraoperative endoscopy for the planning of operations which aimed to correct VPI are presented.Conclusion. This paper presents current aspects of the diagnosis and management of patients with cleft palate and VPI including 3 main aspects: genetics and genomics, speech pathology and imaging diagnosis, and surgical management.

scholarly journals Cutting in-line with iron: ribosomal function and non-oxidative RNA cleavage

2019 ◽  
Author(s):  
Rebecca Guth-Metzler ◽  
Marcus S. Bray ◽  
Moran Frenkel-Pinter ◽  
Suttipong Suttapitugsakul ◽  
Claudia Montllor-Albalate ◽  
...  
Keyword(s):  
Divalent Cations ◽  
Order Rate Constant ◽  
Structure And Function ◽  
List Type ◽  
First Order ◽  
Key Points ◽  
Ribosomal Function ◽  
Continued Use ◽  
And Function

AbstractDivalent metal cations are essential to the structure and function of the ribosome. Previous characterizations of the ribosome performed under standard laboratory conditions have implicated Mg2+ as a primary mediator of ribosomal structure and function. Possible contributions of Fe2+ as a ribosomal cofactor have been largely overlooked, despite the ribosome’s early evolution in a high Fe2+ environment, and its continued use by obligate anaerobes inhabiting high Fe2+ niches. Here we show that (i) Fe2+ cleaves RNA by in-line cleavage, a non-oxidative mechanism that has not previously been shown experimentally for this metal, (ii) the first-order rate constant with respect to divalent cations is more than 200 times greater with Fe2+ than with Mg2+, (iii) functional ribosomes are associated with Fe2+ after purification from cells grown under low O2 and high Fe2+, and (iv) a small fraction of Fe2+ that is associated with the ribosome is not exchangeable with surrounding divalent cations, presumably because it is tightly coordinated by rRNA and buried in the ribosome. In total, these results expand the ancient role of iron in biochemistry and highlight a possible new mechanism of iron toxicity.Key PointsFe2+ cleaves rRNA by a non-oxidative in-line cleavage mechanism that is more than 200 times faster than in-line cleavage with Mg2+;ribosomes purified from cells grown under low O2 and high Fe2+ retain ~10 Fe2+ ions per ribosome and produce as much protein as low O2, high Mg2+-grown ribosomes;a small fraction (~2%) of Fe2+ that is associated with the ribosome is not exchangeable.

Role of Visual Feedback Treatment for Defective /s/ Sounds in Patients With Cleft Palate

1993 ◽  
Vol 36 (2) ◽  
pp. 277-285 ◽  
Author(s):  
Ken-ichi Michi ◽  
Yukari Yamashita ◽  
Satoko Imai ◽  
Noriko Suzuki ◽  
Hiroshi Yoshida
Keyword(s):  
Cleft Palate ◽  
Visual Feedback ◽  
Sound Production ◽  
Speech Training ◽  
Velopharyngeal Function ◽  
Posterior Tongue

The role of visual feedback in the treatment of defective /s/ sounds in patients with cleft palate is described. Six patients with cleft palate who were similar in age, velopharyngeal function, and type of misarticulation were selected for this study. Treatment was provided using either visual feedback or no visual feedback. Visual feedback for tongue placement was provided by the Rion Electropalatograph (EPG). Visual feedback for frication was provided by a multi-function speech training aid (MFSTA). Improvement in /s/ sound production was assessed objectively using a method described previously (Michi et al., 1986). The results indicated that visual feedback for tongue placement and frication was especially useful in the treatment of defective /s/ sounds in patients with cleft palate who exhibited abnormal posterior tongue posturing during the production of dental or alveolar sounds.

The care of patients with gastrointestinal disease and nutritional support for the acutely ill patient

2020 ◽  
pp. 157-194
Author(s):  
Katharine Martyn ◽  
Fiona Creed
Keyword(s):  
Diabetes Mellitus ◽  
Nutritional Support ◽  
Nutritional Assessment ◽  
Gastrointestinal Disease ◽  
Acute Illness ◽  
Normal Anatomy ◽  
Anatomy And Physiology ◽  
Gastrointestinal Conditions ◽  
Gut Function

Acutely ill patients are often admitted to hospital with gastrointestinal conditions, in particular pelvic and abdominal pain. It is therefore essential that nurse has an understanding of the factors that impact on gut function. This chapter will therefore provide an overview of the gastrointestinal (GI) system and explore the normal anatomy and physiology of the GI tract and the accessory organs (liver, gall bladder, and pancreas). It explores the role of the nurse in caring for patients with nausea and vomiting, diabetes mellitus, and the importance of nutritional assessment and management during episodes of acute illness.

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