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61 Cards in this Set
- Front
- Back
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Chapter 6
Screening |
Answers the question “Is a comprehensive evaluation needed?”
Allows clinician to better plan a comprehensive evaluation, if needed (what measures to use, etc.) DOES NOT ESTABLISH A DIAGNOSIS only demonstrates need for further testing |
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Identification
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Can they tell the difference between the target and another sound?
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Comprehensive Evaluation
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Answers the question “Is treatment appropriate?”
Determine appropriate treatment targets Determine best method for treatment More detailed complete collection of data |
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Evaluation Battery
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Articulation test / citation based
Stimulability Spontaneous speech sample Oral Mechanism Exam (what domains are tested an how?) Hearing Screening Perceptual testing Language screen/evaluation Cognitive testing |
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What is the value of making an initial impression prior to collecting data?
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Aids in planning and organizing the remainder of the assessment.
ex. are they intelligible or not? affects consonants and vowels? denasality? loudness? etc |
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Articulation Tests
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-Isolated words – not real world, some productions are better at single word level
-Context is not controlled (e.g., on GFTA) *girl probes/g/ in initial position *cup probes /k/ in initial position *Which context is more facilitative for velars? Don’t typically include phonological assessment (don’t look at phonological processes) -However, this can be added (Khan Lewis can be used to analyze phonological processes in GFTA responses) |
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Articulation Tests Pros
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Easy to give and score
Minimal time Results provide clinician with a quantifiable list of "incorrect" sound productions in different word positions |
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Articulation Tests Cons
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Single- word responses
Doesn't give enough info on their phonological system Doesn't tests all sounds in all the contexts in which they occur in GAE Sounds tested do not occur in comparable phonetic contexts (not context controlled) Only tests very small portion of their articulatory behavior |
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Stimulability Testing
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Refers to testing the client’s ability to produce a misarticulated sound in an appropriate manner when “stimulated” by the clinician to do so
Typically a model is provided of the sound in isolation Impacts when sounds are targeted in treatment "Watch and listen to what i am going to say, and then you say it." |
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Oral Mechanism Exam - OME
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Head and Facial Structures
Respiration Oral and Pharyngeal Cavity Structures Teeth/Dentition Tongue Hard and Soft Palate Functional Assessment of Speech Mechanism Range of motion Velopharyngeal closure Diadochokinesis (DDK)- PTK Gross defects suggest organic etiology and should result in a physician referral |
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Emerging Phonology
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Children are continually developing phonological skills
However, emerging phonology refers to a period in which conventional words are just beginning to emerge -toddlers -older children with severe language deficits Time span during childhood where conventional words begin to appear as a means of communication. |
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Why should you transcribe the entire word when giving citation-based tests?
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If a word contains any aberrant vowel or consonant productions.
Complements the test information considerably and supplies insights into vowels and consonant cluster productions as well. |
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What is the reasoning for supplementing articulation tests with additional utterances?
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To address the noted problems of the client
The target sound/s should be sampled in various vowel contexts and word positions |
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How might one organize a continuous speech sample so that particular sounds are attempted by the speaker?
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Provide objects or pictures that may elicit targeted sounds
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Why is it important to transcribe as much of the speech sample live as possible?
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Live transcriptions have the advantage of capturing phonetic detail that may be lost with a tape recording.
Decreases the subsequent transcription time. |
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Spontaneous Speech Sample
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Although transcription and analyses can be time consuming, a single speech sample can provide a wealth of information including
-percent intelligible words or syllables -Independent or relational analysis -percent consonants correct -phonological process analysis -language analyses (mean length of utterance, etc.) |
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What is the purpose of evaluating the speech mechanism?
How might findings change therapy? |
an evaluation of both the structure and the function of the clients speech mechanism is a prerequisite for any comprehensive appraisal.
Its intent is to assess whether the system appears adequate for regular speech sound production. If organicity is noted, further testing by the clinician and/or referral to a medical expert are warranted. |
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What to look for when evaluating the Speech Mechanism?
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Head
Facial Structures Breathing Oral Cavity (teeth and tongue) Pharyngeal Cavity (hard and soft palates) Functionality of the Speech Mechanism (diadochokinetic) |
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What is the purpose for measuring diadochokinetic rates? What does this task look like?
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Speed of movement of the articulators
Maximum repetition rate of the syllables PU TU KU |
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Why should hearing and language measures be included in an assessment?
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Approximately 80 percent of the clinical population with "delayed speech" have associated language problems. Therefore language testing is recommended for every child who has an articulation and or a phonological disorder.
Hearing screening is essential |
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Challenges associated with children with emerging phonology difficulties
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Depending on the childs developmental level , the administration of standardized articulation tests and stimulability measures might not be possible because these children are not yet skilled at following directions or imitating.
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What are some adaptations that can be made to deal with challenges of emerging phonology during assessment?
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Articulation Tests and Stimulability-Have the family tape-record the child saying specific spontaneous and elicited words at home.
Have the caregiver bring from home a few objects that the child can name. Have the caregiver keep a log of the intended words that the child can produce as well as the approximate way in which each word was pronounced. Spontaneous Speech Sample- Observations of the childs communicative interaction with the caregivers before or after the session may help. Examination of the oral-facial structures and the speech motor system- Pretending to make clown or fish faces together. Letting the child look into your mouth with a small flashlight, and then pretend to look for a dinosaur or elephant in the childs mouth. Wait til the child becomes more acquainted with the clinician and then attempt procedure again and or gather info about their feeding and babbling behaviors. Hearing Screening- if failed they need to be referred for a comprehensive audiological exam. |
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Improve ability to ascertain intended message for relational analysis
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Context of conversation is known to clinician
Clinician can choose a topic Use text free storybook – “what is happening here?” Ask child to describe a procedure – how you hit a baseball, change a tire, put on your clothes, make a sandwich – predictable steps |
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Elbert Article
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Group data – valuable, but…
Individual learning curves show that some generalize learning better than others (trained /s/ generalized to /z/ but not /r/) Children vary by phonological knowledge: The degree to which underlying representations of phonemes within words are adult-like. May not be obvious based on error patterns. Phonological knowledge not necessarily conscious Final consonant deletion Productive knowledge demonstrated by use of doggie in addition to [dɑ] Acoustic analysis: In CVCs ending in voiced consonant, used longer vowel duration than CVC ending in voiceless consonant – [dɑ] for “dog” had a longer duration vowel than [dɑ] for “dock.” Phonological knowledge indexed by these acoustic measures predicted treatment progress Targeting least phonological knowledge (e.g., least stimulable) first resulted in greater change across the speech sound system. |
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Elbert in Summary
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The field has progressed from motor learning approaches to linguistically-based approaches to speech sound development.
Individual learning curves are important Phonological knowledge may predict learning patterns in treatment Assessing and targeting areas of least phonological knowledge may facilitate the greatest change in a child’s phonological system |
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Chapter 9/10
Traditional/ Therapy Progression |
Sensory/Perceptual Training/Ear Training
Production of Sound in Isolation or in Facilitating Contexts Production -Nonsense syllables -Words -Phrases and Sentences (carrier phrases to novel sentences) -Spontaneous Speech Dismissal and Re-evaluation |
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Sensory Perceptual Training
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Identification – give sound a name, contrast with other sounds, identify in isolation
Isolation – child isolates sound within words, phrases, and sentences Stimulation – production variations (different speaker, louder, softer, slower faster) Discrimination – clinician’s presentations of error productions are identified Self-Monitoring – important phase of all therapy |
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Methods of Production Training
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Auditory Stimulation/Imitation – “watch me and do exactly what I do.” (like stimulability)
Phonetic Placement – where to put articulators (e.g., “put the tip of your tongue behind lower teeth”) Sound Modification – Deriving target sound from phonetically similar sound (t to s) Facilitating Contexts – Using coarticulatory effects to elicit norm production (e.g., following [ʃ] with rounded vowels) |
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Bauman Wranlger Text: Re-Eliciting Sounds
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You do not need to know these pages, but…
If you are one day treating an articulation client, these will become invaluable For this class, be able to identify, based on phonetic features, what articulatory contexts are facilitative or counterproductive (e.g., if treating [r] ➙ [w], avoid contexts with labials |
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Minimal Pair Contrast Theory
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Beginning phase of therapy begins with minimal pairs
The two words chosen for each pair differ by one sound – the two sounds differ by only one or two features Example: pan and fan differ only in manner (fricative vs. stop). Otherwise similar in place and voicing |
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How to create minimal pairs
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Choose the substitution sound and target which differ by the least number of features (e.g., f/v)
Target earlier developing sounds (based on norms) Prioritize substitutions that negatively impact intelligibility Begin with stimulable sounds |
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Treatment with minimal pairs involves
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Discrimination
-familiarize child with the words and sounds -test ability to tell the difference between the two words perceptually Imitation -Beginning stage of production training -Traditional elicitation used, but at the word level Spontaneous Production -Relying on the natural communication breakdown resulting from collapse of the two phonemes |
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Maximal Oppositions
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Similar to minimal pairs, pairs of words differ by only one phoneme
In contrast, the phonemes differ by as many phonetic/production features possible Evidence has indicated that the most change occurred when neither of the two phonemes were in the child’s inventory Perceptual training not part of this approach |
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How to create a maximal opposition
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Two sounds not in the child’s inventory are selected
The sounds differing by the most number of distinctive features are chosen Examples are [l] vs. [k] – how do they differ? Maximal opposition could be “loop” and “coop” (notice features of the stimulus words) |
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Cycles Approach
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Phonological patterns trained in finite period, then a new pattern is trained
Rotation or cycling of treatment targets is not contingent on mastery (percent accuracy) Each period of treatment stimulates emergence of the speech sounds or patterns Specifically designed for children with low intelligibility |
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What sound or sound patterns are targeted first?
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Omission processes – impacting syllable structure – sounds earlier developing as targets
Anterior-posterior contrasts (velar-alveolar) S-clusters – word final most facilitating Liquids – should begin to work on emergence early on in treatment |
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Dialect
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a neutral label that refers to any variety of a language that is shared by a group of speakers.
Dialects also encompass specific use of vocabulary, word forms, sentence structure and melodic patterns. |
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Formal Standard English
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applied primarily to written language and the most formal spoken language situations, tends to be based on the written language and is exemplified in guides of usage or grammar texts.
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Standard English
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Dialect of American English
For this reason, the more neutral label “General American English” (GAE) is preferred |
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Vernacular Dialects
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those varieties of of spoken American English that are considered outside the continuum of Informal Standard English.
Presence of certain structures. ex. double negatives, lack of subject verb agreement, using variations from standard verb forms |
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Regional Dialects
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those dialects corresponding to various geographical locations
US : North South Midland- considerably more diversity West |
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Social/Ethnic Dialects
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those dialects that are generally related to socioeconomic status and or ethnic background
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African American English
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Habitual be - a feature of African American English
Use of uninflected to be to indicate habitual or recurring actions, as in a sentence like “He always be late for dinner.” NOT typically used in sentences indicating long-term states or one-time actions. For example, speakers of AAE would say “He’s nice” or “He nice” rather than “He be nice” |
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African American English
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Differences affecting
-phonological -morphological -syntactical -semantic -pragmatic |
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Not all African Americans use AAE.
How can this be explained? |
age- usually decreases as they become older
gender- males use AAE more socioeconomic status- lower, and working class use more AAE (middle and upper middle class code switch) |
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What four steps can an SLP make to assure AAE dialect is taken into account during assessment?
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1. Be sensitive to local dialect patterns and to any regional or cultural dialects that may impact the clients speech.
2. Choose assessment instruments that account for dialectal variations or consider dialect features when scoring any standardized measure. If none clinicians knowledge of dialectal features will be helpful in scoring these measures. 3. Evaluate not only the presence of specific dialect features but also their frequency of occurrence. 4. Assess the clients communicative effectiveness in the regional or cultural dialect. |
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More strategies for assessment
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Be knowledgeable about the child’s dialect (and don’t assume race or ethnicity = dialect)
Ask for parents to take an articulation test, using the dialect normally spoken at home – note variations Assess child’s communicative effectiveness in his home language Ask parents whether the child performs similarly to same-language or dialect peers Observe child interacting with same-language or dialect peers, family members, etc. |
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How can you assess what the childs home dialect is?
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Ask other members of the childs dialect community/family
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How can you determine if the production pattern is consistent with the childs home dialect once you have ascertained what it is?
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Listen to the caregivers productions of the target
Consult related dialectal materials Compare findings to childs productions |
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Treatment: Difference ≠ Disorder
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SLPs are not meant to identify children with non-standard dialects for speech-language treatment
However, some individuals choose to make their dialects more consistent with GAE – SLPs can help with this (example is the English Language Proficiency Clinic here at KSU) |
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Childhood Apraxia of Speech (CAS)
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Definition: A motor speech disorder characterized by a lack of sequential volitional control of the oral mechanism, not attributable to other disorders of muscular control (no apparent neurological basis)
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What characteristics of CAS seem to differ from more typical speech sound disorders?
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Segmental
-Less stability with vowel and consonant errors -Reduced % glides correct (w, j) Suprasegmentals -Phrasing: Increased repetitions and revisions (also groping and silent posturing of articulators) -Less stable rate, stress, pitch, laryngeal quality, and resonance Other characteristics: less facility with rhyming and other phonological awareness skills *Large marker: instability over repeated trials |
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CAS Symptoms also consistent with other motor speech disorders (such as dysarthria)
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Segmental: reduced vowel space, lengthened vowels, distorted rhotics, lengthened cluster durations, increased % phoneme distortions, increased within-word pauses
Suprasegmental: -Rate: slower speaking rate, -Stress: abnormally high or low stress patterns, -Pitch: raised fundamental frequency mean and range, -Resonance: increased nasopharyngeal resonance (“muffled,” “back of the throat” quality consistent with the percept of “sluggish or imprecise tongue movement” (often used to describe speech of people with Down’s Syndrome) |
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Treatment of CAS
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Treatment will be intensive
Activities and targets progress from easy to difficult (begin with strengths) Treatment focuses on sequences of movements – essentially building motor programs |
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Cerebral Palsy
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A neurological disorder, which impairs muscle movement and often results in dysarthria
Caused by damage to the brain during pre-, peri-, or early postnatal periods – wide range of ability -Assess cognitive and language ability -Assess sensory modalities (hearing, visual acuity) Many speech subsystems typically affected (respiratory, laryngeal, velopharyngeal, articulatory) -Assess all subsystems -Assess pre-speech skills (prerequisites for speech) *most common developmental motor impairment |
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Treatment with CP- typically a team approach
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If pre-speech prerequisites are not present, should target these first
Reducing abnormal oral reflexes has been suggested, but is controversial Speech sound target selection guided by -stimulability -visibility -early developing Multiple modes of input preferred (auditory and visual) Norm production often not attainable -Focus on intelligibility -Palatometry -Alternative and augmentative communication (AAC) |
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Arctic and Phonological Characteristics of CP
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Spasticity- legs and or arms being more involved than other legs and or arms
Dyskinesia- unilateral or bilateral disturbances of posture, tonus, and motion Ataxia- incoordination of essentially hypotonic muscle action |
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Mental Disabilities (MD) – Assessment Considerations
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Significantly below average intelligence
70% have speech production difficulty Limitations in 2 or more adaptive living skills (e.g., communication, self care, functional academics, work, etc.) – manifests before age 18 -Language and standard speech sound assessment (including intelligibility) -What are functional communicative needs in the environment? Nearly half tested manifest hearing impairments -Need hearing assessment |
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Treatment with MD individuals: Guiding Principles
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1.Overlearning and repetition is encouraged
2.Train in natural environment 3.Begin early on in development 4.Follow developmental sequence 5.Concentrate on overall intelligibility rather than individual sounds |
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Hearing Impairment: Articulatory Characteristics and Assessment Considerations
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Speech errors related to auditory perceptual skill
-look at audiologist report, consult with audiologist Consonant and Vowel Errors Prosodic and resonance issues -Conversational speech sampling is key to assess this and speech intelligibility |
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Treatment for Hearing Impaired
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Prerequisites: amplification used habitually (not just during therapy session) – communication with audiologist
Direct attention to specific oral/facial movements accompanying suprasegmental and segmental production Maximizing sensory feedback (multi-modal) Primarily focused on speech intelligibility and articulatory accuracy |
