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Purpose: Speech disorders associated with velopharyngeal dysfunction (VPD) are common. Some require surgical management, while others are responsive to speech therapy. This is related to whether the speech error is obligatory (passive) or compensatory (active). Accurate identification of speech errors is necessary to facilitate timely and appropriate intervention. Recent studies have supported the role of magnetic resonance imaging (MRI) in the assessment process for VPD. The purpose of this study was to utilize MRI to support differential diagnosis and treatment planning in a child presenting with inconsistent nasal air escape, mild hypernasality, and compensatory speech errors. Method: A nonsedated, fully awake, velopharyngeal (VP) MRI protocol was implemented to acquire anatomic data at rest and during phonation. Segmentations and visualization of the tongue, palate, adenoids, and nasopharyngeal airway were completed. Anatomic linear measurements were obtained for VP variables to assess VP function, establish a baseline, and monitor change over time. Results: VP anatomy was successfully visualized on MRI in multiple imaging planes. All anatomic measurements fell within normative expectations. Elevation and retraction of the soft palate occurred against the adenoid pad. A pharyngeal fricative was documented, resulting a small VP gap during speech. In contrast, adequate VP closure was obtained for vowels and other oral consonant sounds. Conclusions: Quantitative assessment and visualization of the anatomy demonstrated adequate VP closure capabilities and a pharyngeal fricative substitution that had not been adequately perceived during routine clinical assessments. This study suggests a promising additive role for VP MRI for enhanced differential diagnosis and therapeutic monitoring in children with VPD and concomitant speech disorders. Supplemental Material: https://doi.org/10.23641/asha.27905451 [ABSTRACT FROM AUTHOR]

Objective : Challenges providing cleft/craniofacial care in rural communities are often reported, leading to disparities in resources available to clinicians. The purpose of this study was to identify the impact of rurality on caseloads and practice patterns of speech-language pathologists (SLPs) regarding speech and velopharyngeal function for children with cleft lip and/or palate (CL/P). Design : A national, survey of US-based SLPs (N = 359 respondents) investigated resources, comfort level, caseloads, and practice patterns for children with CL/P. Sub-county classifications that delineated levels of rurality were utilized. Descriptive statistics and chi-square analyses were conducted to determine the impact of population density on assessment and referral decisions. Results : Nearly 83% of SLPs reported providing care for a child with CL/P and 41.4% of these SLPs reported five or more children with CL/P on caseload throughout their career. There were no significant differences in rurality of practice setting and the likelihood of treating a child with CL/P. Significant differences were present between rural, town, suburban, and metropolitan-based SLPs regarding available resources (p = 0.035). SLPs in rural settings reported feeling uncomfortable treating children with CL/P compared to those in metropolitan settings (p = 0.02). Distance to the cleft/craniofacial team and comfort levels impacted referral decisions. Conclusions : Most SLPs report having children with CL/P on caseload regardless of practice location. Rurality impacted assessment and referral decisions, especially surrounding access to resources and comfort levels engaging in team care. Findings have implications for developing support systems and reducing barriers for rural SLPs working with children born with CL/P. [ABSTRACT FROM AUTHOR]

Purpose: Finite element (FE) models have emerged as a powerful method to study biomechanical complexities of velopharyngeal (VP) function. However, existing models have overlooked the active contributions of the lateral pharyngeal wall (LPW) in VP closure. This study aimed to develop and validate a more comprehensive FE model of VP closure to include the superior pharyngeal constrictor (SPC) muscle within the LPW as an active component of VP closure. Method: The geometry of the velum and the lateral and posterior pharyngeal walls with biomechanical activation governed by the levator veli palatini (LVP) and SPC muscles were incorporated into an FE model of VP closure. Differing muscle activations were employed to identify the impact of anatomic contributions from the SPC muscle, LVP muscle, and/or velum for achieving VP closure. The model was validated against normative magnetic resonance imaging data at rest and during speech production. Results: A highly accurate and validated biomechanical model of VP function was developed. Differing combinations and activation of muscles within the LPW and velum provided insight into the relationship between muscle activation and closure patterns, with objective quantification of anatomic change necessary to achieve VP closure. Conclusions: This model is the first to include the anatomic properties and active contributions of the LPW and SPC muscle for achieving VP closure. Now validated, this method can be utilized to build robust, comprehensive models to understand VP dysfunction. This represents an important advancement in patient-specific modeling of VP function and provides a foundation to support development of computational tools to meet clinical demand. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to identify training gaps and continuing education (CE) needs for speech-language pathologists (SLPs) in evaluating and treating children with cleft palate across and among areas of varying population density. Method: An anonymous 35-question survey lasting approximately 10-15 min was created in Qualtrics based on a previously published study. The survey information and link were electronically distributed to American Speech-Language-Hearing Association (ASHA)-certified SLPs through ASHA listservs, social media, individual-state SLP organizations, and an e-mail list of publicly listed SLPs. A total of 359 survey responses were collected. Results: Respondents varied in terms of age, type of certification, practice location, and clinical experience with cleft palate, with the largest percentage (46.7%) of respondents in a school-based setting. Only 28.5% reported currently feeling comfortable treating children with cleft palate. Respondents reported conventions/conferences (25.4%) and webinars (23.2%) were the most helpful resources, but DVDs were frequently not used for CE. Information from the child's cleft team (84.4%) and mentors/colleagues (70%) were considered high-quality resources. Respondents indicated information on treatment of articulation (79.2%) and resonance (78.4%) disorders as well as specific therapy techniques (76.9%) would be very helpful for clinical practice. Population density significantly influenced how respondents ranked the perceived helpfulness and quality of different resources as well as desired topics for future resources. Conclusions: There is a continued need for adequate training and CE opportunities for SLPs, particularly related to assessing and treating children with cleft palate. Increased access to high-quality CE resources will be key to filling educational gaps present for SLPs, especially in areas of low-population density. [ABSTRACT FROM AUTHOR]

Objective: The use of magnetic resonance imaging (MRI) in the assessment process for children with cleft/craniofacial conditions remains uncommon, particularly for velopharyngeal assessments. The purpose of this study was to analyze the perceived clinical utility of MRI for cleft/craniofacial providers and identify barriers that exist for clinical translation of this imaging modality to this population of patients. Methods: A 38-item survey was disseminated to craniofacial team providers. Workplace context and demographics, MRI as a research and clinical tool, access and barriers for use of MRI, and needs for successfully establishing MRI protocols at clinical sites were investigated. Descriptive statistics were used to identify differences in the clinical use of MRI across disciplines. Chi-square analyses were conducted to determine how different specialties perceived potential barriers. Results: Respondents reported that MRI is likely to be beneficial for clinical assessments (93.5%) and that this imaging modality is available for use (83.8%). However, only 11.8% of providers indicated the use of MRI in their clinical assessments. This discrepancy highlights a potential disconnect between perceived use and implementation of this imaging methodology on cleft and craniofacial teams. A number of barriers were identified by providers. Challenges and opportunities for clinical translation of MRI protocols were highlighted. Conclusion: Results may guide the development for improved clinical feasibility and implementation of MRI for clinical planning in this population of patients. Reported barriers highlight additional areas for translational research and the potential for the development of clinical tools related to MRI assessment and protocol implementation. [ABSTRACT FROM AUTHOR]

The purpose of this study was to develop a framework for 3D subject-specific computational models capable of simulating velopharyngeal biomechanics for anatomic changes that occur following pharyngoplasty and to gain insight into biomechanical factors that may lead to different speech/surgical outcomes. Patient-specific models for two, matched participants with differing speech/surgical outcomes were developed: one with a successful pharyngoplasty outcome and one with a failed pharyngoplasty outcome. Surgical scenarios were simulated to model pharyngoplasty location, identify LVP muscle biomechanics, and identify an optimal pharyngoplasty location for each participant. These simulations illustrate the potential for optimizing pharyngoplasties based on patient-specific geometry. [ABSTRACT FROM AUTHOR]