The impact of perceptual and instrumental measures in palatal lift fitting

By M. Hakel, J. Garcia, D.R. Beukelman, and J. Marshall

 

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 participantís speech during 33-month intervention.