The
impact of perceptual and instrumental measures in palatal lift fitting
This presentation addresses the decision making process
in the fitting of a palatal lift for a young man with a severe oropharyngeal dysphagia and dysarthria, through use of perceptual and instrumental data
related to treatment modifications. Specifically, the use of intelligibility
scores, phoneme intelligibility, nasal airflow and intra-oral air pressure from
aerodynamic assessments and direct visualization through naso-endoscopy
are highlighted as they relate to judgements regarding the effectiveness of the
palatal lift modification. The
participant was a 12-year old boy with cranial nerve damage following removal
of a brainstem benign tumor. At the time
of his referral, he was approximately 6 weeks post-surgery and presented with a
significant oropharyngeal dysphagia
and severe, flaccid dysarthria (4.5%). Naso-endoscopic exam revealed no movement of his palate or
pharyngeal walls during speech; however, he achieved velopharyngeal
closure during swallow attempts. At that time he was NPO and was unable to
clear oral and pharyngeal secretions. He demonstrated an active gag
response. Given his severe velopharyngeal impairment, a palatal lift was
recommended. The purpose of this report
is to document and discuss how the contributions of sentence intelligibility,
phoneme intelligibility, aerodynamic, and naso-endoscopic
measures changed relative to the severity of the participant’s speech during
33-month intervention.