Velopharyngeal closure can not be evaluated, since the naso-pharynx cannot be seen. The speaker nasalized the vowel. Large adenoids may prevent the velum from elevating. The velum may be paralyzed. The oral surface may not move but the nasal surface elevates.
Velopharyngeal problems are low incidence.
There are not many patients or experienced clinicians to learn from. The velopharyngeal valve is not easy to visualize. What we can see on an oral exam is only a small part of the picture. Outdated and unfounded therapy techniques continue to be used, such as sucking exercises. This causes under-referral to cleft palate teams.