The Experts below are selected from a list of 924 Experts worldwide ranked by ideXlab platform
Bruce E Murdoch - One of the best experts on this subject based on the ideXlab platform.
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an evaluation of continuous positive airway pressure cpap therapy in the treatment of hypernasality following traumatic brain injury a report of 3 cases
Journal of Head Trauma Rehabilitation, 2004Co-Authors: Louise M Cahill, Deborah Theodoros, Aimee B Turner, Penelope A Stabler, Paula E Addis, Bruce E MurdochAbstract:Objective: To evaluate the effectiveness of continuous positive airway pressure (CPAP) therapy in the treatment of hypernasality following traumatic brain injury (17111). Design: An A-B-A experimental research design. Assessments were conducted prior to commencement of the program, midway, immediately posttreatment, and 1 month after completion of the CPAP therapy program. Participants: Three adults with dysarthria and moderate to severe hypernasality subsequent to TBI. Outcome Measures: Perceptual evaluation using the Frenchay Dysarthria Assessment, the Assessment of Intelligibility of Dysarthric Speech, and a speech sample analysis, and instrumental evaluation using the Nasometer. Results: Between assessment periods, varying degrees of improvement in hypernasality and sentence intelligibility were noted. At the 1-month post-CPAP assessment, all 3 participants demonstrated reduced nasalance values, and 2 exhibited increased sentence intelligibility. Conclusions: CPAP may be a valuable treatment of impaired Velopharyngeal Function in the TBI population.
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motor speech impairment following traumatic brain injury in childhood a physiological and perceptual analysis of one case
Pediatric Rehabilitation, 1998Co-Authors: Deborah Theodoros, Nina Shrapnel, Bruce E MurdochAbstract:The physiological and perceptual characteristics of persistent dysarthria exhibited by a 14 year-old boy, following a severe traumatic brain injury (TBI) were investigated. The subject's speech and motor speech mechanism were comprehensively evaluated both perceptually and physiologically, and the findings were compared with those of a non-neurologically impaired control subject, matched for age and sex, and a number of control groups from previous studies. Overall, the assessments indicated that the major motor speech deficits demonstrated by the subject included severely reduced tongue Function, and moderately impaired lip, laryngeal, and Velopharyngeal Function. Respiratory Function was found to be mildly impaired. Perceptual assessments indicated that the subject's speech was severely impaired in relation to rate, pitch variation, and consonant precision, with a moderate impairment in overall intelligibility. The effects of a severe TBI on the Functioning of the child's motor speech mechanism were discussed. The clinical implications for the assessment and treatment of dysarthria in childhood following severe TBI were highlighted.
Samuel M Noordhoff - One of the best experts on this subject based on the ideXlab platform.
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surgical correction of submucous cleft palate with furlow palatoplasty
Plastic and Reconstructive Surgery, 1996Co-Authors: Philip Kuo-ting Chen, Yu-ray Chen, Kai Fong Hung, Samuel M NoordhoffAbstract:Many surgeons have favored using the pharyngeal flap as the primary treatment for the Velopharyngeal insufficiency associated with submucous cleft palate. However, the increasing number of reports of sleep apnea and airway compromise as a result of pharyngeal flap surgery support the need to eliminate any unnecessary pharyngeal flap surgery. From 1988 to 1993, 35 Chinese submucous cleft palate patients with Velopharyngeal insufficiency received surgery. A Furlow palatoplasty was used in 30 patients (3 to 26 years old). The follow-up duration was 9 months to 5 1/2 years. These patients were selected after a thorough study for Velopharyngeal insufficiency including intraoral examination, perceptual speech assessment, videonasopharyngoscopy, and/or multiview videofluoroscopy. The criteria for selection included age, intraoral finding of an obviously anteriorly inserted levator palatine muscle, size of Velopharyngeal gap, pattern of Velopharyngeal closure, degree of lateral pharyngeal wall movement, and response to biofeedback speech therapy. In general, younger patients with circular or sagittal pattern closure, a Velopharyngeal gap less than 5 mm, or good response to biofeedback speech therapy were considered to be the best candidates for a Furlow palatoplasty. The 5 patients who did not fulfill these criteria and whose Velopharyngeal Function failed to improve on preoperative biofeedback therapy were treated by pharyngeal flap operation. Twenty-nine patients (96.7 percent) achieved competent Velopharyngeal Function after the Furlow palatoplasty. The procedure corrected the Velopharyngeal insufficiency in 3 patients older than 20 years with a Velopharyngeal gap of less than 2 mm. The only patient with an unsatisfactory result was a 26-year-old woman who had very prominent action of the musculus uvulae before the surgery. The results show that a Furlow palatoplasty can satisfactorily correct Velopharyngeal insufficiency in carefully selected submucous cleft palate patients and thus avoid the serious complications of pharyngeal flap surgery.
Suvi Alaluusua - One of the best experts on this subject based on the ideXlab platform.
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the effects of le fort i osteotomy on Velopharyngeal Function in cleft patients
Journal of Cranio-maxillofacial Surgery, 2019Co-Authors: Suvi Alaluusua, Leena Turunen, Anne Saarikko, Ahmed Geneid, Junnu Leikola, Arja HeliovaaraAbstract:Abstract Introduction Maxillary advancement may affect speech in cleft patients. The aim of this study was to evaluate whether preoperative Velopharyngeal (VP) Function and cleft type can predict VP Function after a Le Fort I maxillary osteotomy. Materials and methods One hundred consecutive nonsyndromic cleft patients (54 females, 64 males) who underwent Le Fort I osteotomies were retrospectively evaluated. Pre- and postoperative VP Function was assessed perceptually and instrumentally by a Nasometer. A five-point scale was used to rate Velopharyngeal insufficiency symptoms (VPI 0–4). To assess reliability, 30 video recordings were re-evaluated. Results Preoperatively, 89% of patients had normal or insignificant VPI (0–1), and only 3% had moderate VPI (3). Postoperatively, 77% of patients had VPI values of 0–1 and 14% had moderate to severe VPI values (VPI 3–4). A positive correlation was found between pre- and postoperative VPI scores, whereas the cleft type did not affect speech results. Patients with a preoperatively normal VPI (0) were not at risk for postoperative Velopharyngeal incompetence. Conclusions There was an overall significant negative change in speech after a Le Fort I osteotomy. At-risk patients presented with borderline (1) or more severe VPI (2 and 3) preoperatively.
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validity of auditory perceptual assessment of Velopharyngeal Function and dysFunction the vpc sum and the vpc rate
Clinical Linguistics & Phonetics, 2017Co-Authors: Anette Lohmander, Christina Havstam, Christina Persson, Emilie Hagberg, Elisabeth Willadsen, Inger Lundeborg, Julie Davies, Maria Boers, Mia Kislingmoller, Suvi AlaluusuaAbstract:Overall weighted or composite variables for perceptual auditory estimation of Velopharyngeal closure or competence have been used in several studies for evaluation of Velopharyngeal Function during speech. The aim of the present study was to investigate the validity of a composite score (VPC-Sum) and of auditory perceptual ratings of Velopharyngeal competence (VPC-Rate). Available VPC-Sum scores and judgments of associated variables (hypernasality, audible nasal air leakage, weak pressure consonants, and non-oral articulation) from 391 5-year olds with repaired cleft palate (the Scandcleft project) were used to investigate content validity, and 339 of these were compared with an overall judgment of Velopharyngeal competence (VPC-Rate) on the same patients by the same listeners. Significant positive correlations were found between the VPC-Sum and each of the associated variables (Cronbachs alpha 0.55-0.87, P < 0.001), and a moderately significant positive correlation between VPC-Sum and VPC-Rate (Rho 0.698, P < 0.01). The latter classified cases well when VPC-Sum was dichotomized with 67% predicted Velopharyngeal competence and 90% Velopharyngeal incompetence. The validity of the VPC-Sum was good and the VPC-Rate a good predictor, suggesting possible use of both measures depending on the objective.
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scandcleft randomised trials of primary surgery for unilateral cleft lip and palate 4 speech outcomes in 5 year olds Velopharyngeal competency and hypernasality
Journal of Plastic Surgery and Hand Surgery, 2017Co-Authors: Anette Lohmander, Christina Persson, Elisabeth Willadsen, Inger Lundeborg, Maria Boers, Suvi Alaluusua, Ragnhild Aukner, Anja Bau, Melanie Bowden, Julie DaviesAbstract:AbstractBackground and aim: Adequate Velopharyngeal Function and speech are main goals in the treatment of cleft palate. The objective was to investigate if there were differences in Velopharyngeal competency (VPC) and hypernasality at age 5 years in children with unilateral cleft lip and palate (UCLP) operated on with different surgical methods for primary palatal repair. A secondary aim was to estimate burden of care in terms of received additional secondary surgeries and speech therapy.Design: Three parallel group, randomised clinical trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK.Methods: Three different surgical protocols for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with a non-syndromic UCLP. Speech audio and video recordings of 391 children (136 girls, 255 boys) were available and perceptually analysed. The main outcome measures were VPC and hy...
Takashi Tachimura - One of the best experts on this subject based on the ideXlab platform.
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Change in Levator Veli Palatini Muscle Activity in Relation to Swallowing Volume During the Transition from the Oral Phase to Pharyngeal Phase
Dysphagia, 2006Co-Authors: Takashi Tachimura, Kentaro Okuno, Maki Ojima, Kanji NoharaAbstract:The aim of this study was to examine whether the levator veli palatini (LVP) muscle might be involved in the regulation of Velopharyngeal Function during the transition between the oral and pharyngeal phases during swallowing, and to examine whether LVP muscle activity could be regulated in relation to the volume of swallowing. Eight normal adults participated in this study. Smoothed EMG signals of the LVP muscle were collected. At the same time, palatoglossus muscle activity was also monitored. Each subject swallowed water at five different volumes: 12.5%, 25%, 50%, 100%, and 150 (or 200) % of the optimum volume for swallowing, which was individually determined for each subject. LVP muscle activity was positively correlated with changes in swallowing volume. The LVP muscle was involved in the regulation of swallowing during the transition from the oral to pharyngeal phases.
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prediction of deterioration of Velopharyngeal Function associated with maxillary advancement using electromyography of levator veli palatini muscle
The Cleft Palate-Craniofacial Journal, 2005Co-Authors: Kanji Nohara, Takashi Tachimura, Takeshi WadaAbstract:OBJECTIVE: The purpose of the present study was to examine the possibility that postoperative Velopharyngeal Function following maxillary advancement could be predicted using preoperative electromyography of the levator veli palatini. DESIGN: Levator muscle electromyography was recorded preoperatively during speech and blowing. Levator activity was expressed as a percentage relative to the maximum value observed throughout the experiment. Postoperative Velopharyngeal Function was evaluated by means of perceptual judgment and nasoendoscopy. PARTICIPANTS: The subjects were four patients with repaired cleft palates who underwent maxillary advancement, two by osteotomy and two by distraction osteogenesis. None of the subjects presented with preoperative hypernasality, and nasoendoscopy demonstrated complete Velopharyngeal closure in all subjects prior to maxillary advancement. RESULTS: Preoperative levator activity for speech of two subjects was similar to that for normal speakers (< 60% of total range), and postoperative nasality and nasoendoscopic findings revealed no detectible changes. For the other two subjects, levator activity for speech exceeded 60% of the total range, similar to that of speakers with Velopharyngeal incompetence. These subjects showed increased hypernasality and deteriorated Velopharyngeal closure following maxillary advancement. CONCLUSION: The deterioration of Velopharyngeal Function associated with maxillary advancement was demonstrated for subjects whose levator activity was at higher levels during speech in comparison with maximal activity observed during blowing, regardless of the amount of maxillary advancement. Preoperative levator muscle electromyography could be a predictor in identifying patients at higher risk of postsurgical deterioration of Velopharyngeal Function.
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morphological evaluation of changes in Velopharyngeal Function following maxillary distraction in patients with repaired cleft palate during mixed dentition
The Cleft Palate-Craniofacial Journal, 2004Co-Authors: Koichi Satoh, Takeshi Wada, Takashi Tachimura, Junko Nagata, Kenji Shomura, Jinichi Fukuda, Ryosuke ShibaAbstract:Abstract Objective: To describe the morphological changes of nasopharyngeal components after maxillary distraction and clarify whether the morphological characteristics are related to Velopharyngeal Function (VPF). Design: Perceptual judgments of hypernasality and nasendoscopy were performed before and after treatment. Lateral cephalograms were obtained to describe the morphological changes. Setting: Department of Oral and Maxillofacial Surgery, Miyazaki Medical College, Miyazaki, Japan. Participants: Nine patients with repaired cleft palate in the mixed dentition stage underwent maxillary distraction using a face mask and an intraoral fixed appliance system. Outcome Measures: The severity of hypernasality, Velopharyngeal insufficiency, and measurements such as pharyngeal depth, velar length, and the rotation of the palatal plane were evaluated. Results: Increase in pharyngeal depth was not always proportional to the amount of advancement. It depended on the posture of the posterior pharyngeal wall and th...
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effect of temporary closure of oronasal fistulae on levator veli palatini muscle activity
The Cleft Palate-Craniofacial Journal, 1997Co-Authors: Takashi Tachimura, Hisanaga Hara, Hideyasu Koh, Takeshi WadaAbstract:Abstract Objective: The objective of this study was to clarify electromyographically the effects of closing an oronasal fistula on levator muscle activity and oral air pressure in patients with Velopharyngeal incompetence and in those with adequate Velopharyngeal Function. Subjects: Five patients with adequate Velopharyngeal Function and six patients with Velopharyngeal incompetence were studied. All subjects had an oronasal fistula at the anterior third portion of the hard palate in spite of primary palatal closure using palatal push-back operation. Outcome Measures: The smoothed electromyographic activity of the levator veli palatini muscle was measured with the fistula closed with a cotton swab dipped in saline and with the fistula left open. Results: Under the closed fistula condition, oral air pressure was greater than that observed under the open fistula condition irrespective of Velopharyngeal Function. Levator veli palatini muscle activity was significantly lower in magnitude under the condition o...
Kanji Nohara - One of the best experts on this subject based on the ideXlab platform.
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Change in Levator Veli Palatini Muscle Activity in Relation to Swallowing Volume During the Transition from the Oral Phase to Pharyngeal Phase
Dysphagia, 2006Co-Authors: Takashi Tachimura, Kentaro Okuno, Maki Ojima, Kanji NoharaAbstract:The aim of this study was to examine whether the levator veli palatini (LVP) muscle might be involved in the regulation of Velopharyngeal Function during the transition between the oral and pharyngeal phases during swallowing, and to examine whether LVP muscle activity could be regulated in relation to the volume of swallowing. Eight normal adults participated in this study. Smoothed EMG signals of the LVP muscle were collected. At the same time, palatoglossus muscle activity was also monitored. Each subject swallowed water at five different volumes: 12.5%, 25%, 50%, 100%, and 150 (or 200) % of the optimum volume for swallowing, which was individually determined for each subject. LVP muscle activity was positively correlated with changes in swallowing volume. The LVP muscle was involved in the regulation of swallowing during the transition from the oral to pharyngeal phases.
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prediction of deterioration of Velopharyngeal Function associated with maxillary advancement using electromyography of levator veli palatini muscle
The Cleft Palate-Craniofacial Journal, 2005Co-Authors: Kanji Nohara, Takashi Tachimura, Takeshi WadaAbstract:OBJECTIVE: The purpose of the present study was to examine the possibility that postoperative Velopharyngeal Function following maxillary advancement could be predicted using preoperative electromyography of the levator veli palatini. DESIGN: Levator muscle electromyography was recorded preoperatively during speech and blowing. Levator activity was expressed as a percentage relative to the maximum value observed throughout the experiment. Postoperative Velopharyngeal Function was evaluated by means of perceptual judgment and nasoendoscopy. PARTICIPANTS: The subjects were four patients with repaired cleft palates who underwent maxillary advancement, two by osteotomy and two by distraction osteogenesis. None of the subjects presented with preoperative hypernasality, and nasoendoscopy demonstrated complete Velopharyngeal closure in all subjects prior to maxillary advancement. RESULTS: Preoperative levator activity for speech of two subjects was similar to that for normal speakers (< 60% of total range), and postoperative nasality and nasoendoscopic findings revealed no detectible changes. For the other two subjects, levator activity for speech exceeded 60% of the total range, similar to that of speakers with Velopharyngeal incompetence. These subjects showed increased hypernasality and deteriorated Velopharyngeal closure following maxillary advancement. CONCLUSION: The deterioration of Velopharyngeal Function associated with maxillary advancement was demonstrated for subjects whose levator activity was at higher levels during speech in comparison with maximal activity observed during blowing, regardless of the amount of maxillary advancement. Preoperative levator muscle electromyography could be a predictor in identifying patients at higher risk of postsurgical deterioration of Velopharyngeal Function.
