Aud 815 Speech Pathology

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Speech

Back 1

The verbal means of communicating.

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Articulation

Back 2

How you make the sounds.

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Voice

Back 3

The use of vocal folds and breathing to make your sounds.

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Fluency

Back 4

Flow of the speech.

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Language

Back 5

Being made up of socially shared rules that include semantics, morphology, syntax and pragmatics.

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Semantics

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What words mean.

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Morphology

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How to make new words. e.g. cat --> cats. Internal organization of words.

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Syntax

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Linguistic rules for organizing word order in a given language.

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Pragmatics

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What word combination are best in what situations.

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Receptive vs. expressive

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Receptive: ability to understand language.
Expressive: ability to produce language.

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Three components of language

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Form, content, use.

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Language Form

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The structure of language. Involves: Phonology, morphology and syntax.

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Phonology

Back 13

Study of sounds used to make words (more related to speech than language).

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Language Content

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The component of language that relates to meaning. Semantics = the linguistic representation of objects, ideas, feelings, and events as well as the relations between these.

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Language Use

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Pragmatics = sociolinguistic use of language (what to say to whom, how to say it, and when to day it)

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Linguistic competence

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An inner knowledge of the rules of language.

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Communicative competence

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The use of one's knowledge of language in a variety of settings (also referred to as language performance).

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Receptive language abilities

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Birth: startle to loud noise, turn head toward sound source, preference for mother's voice, discriminate many sounds used for speech.
1-2 months: smile when spoken to.
3-7 months: can discriminate different intonations.
8-12 months: responds to name, recognizes some words and phrases.

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Expressive Language Stages

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Stage 1: reflexive vocalizations
Stage 2: cooing and laughter
Stage 3: vocal play
Stage 4: canonical babbling
Stage 5: jargon

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Early non-word communicative functions can be classified into two categories

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Imperative communicative functions: rejection & request.
Declarative communication function.

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Communicative behaviors that emerge before the first spoken words

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Pointing, eye contact, gestures, protowords.

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Developmental milestones during early lexical development

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By 18 months should have 10-20 words. By 24 months should have ~200 words.

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Why do nouns tend to develop earlier than verbs?

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Reflects that input that they got from their communicative models. Verbs are more linguistically complex.

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Early semantic errors occur because of

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Overextension and underextension

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How do we measure syntax?

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MLU = mean length of utterance

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Brown's Stages of Syntactic Development

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Stage I = MLU of 1.0 to 1.99
Stage II = MLU of 2.0 to 2.49
Stage III = MLU of 2.5 to 2.99
Stage IV = MLU of 3.0 to 3.49
Stage V = MLU of 3.5 to 4.0*
When MLU is beyond 4.0, it is no longer a valid indicator of what a child knows about language
Only designed to be used with English speaking children

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Brown's Stage 1

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Utterances are simple and consist mainly of open class words. Closed class words develop at later stages. Utterances at this stage are considered telegraphic due to the lack of function words.

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Development of grammatical morphemes

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Stage 1: none
Stage 2: present progressive, regular plurals, preposition "in".
Stage 3: possessive "s", proposition "on"
Stage 4 and early 5: no new morphemes
Late stage 5: regular past tense “-ed”, irregular past tense (ran, ate), regular third person singular present tense “s” (he sleeps, mommy eats), definite (the) and indefinite (a, an) articles, contractible copula (“I’m special”).
Stage 5+: contractible auxiliary (Daddy’s going to bed), uncontractible copula (This is his friend), uncontractible auxiliary (She did write the poem), irregular third person “s” (He has the book)

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Language disorder

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The impairment or deviant development of comprehension and or use of a spoken, written and/or other symbol system. The disorder my involve the form content and/or use of language.

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Prevalence of language disorders

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Affects 5-8% of preschool aged children.
Affects 8-12% of school aged children.

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How is language evaluated in children?

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Standardized assessment. criterion-referenced assessment, dynamic or nonbiased assessment.

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Educational approaches

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Oral/aural (CI and HA children), Total communication, Bilingual/bicultural

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Williams Syndrome

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Characterized by impaired cognition but apparently "intact or even precocious" language skills. Language skills still show impairment, especially in the areas of speech perception, early vocabulary and complex vocabulary development, pragmatic development, and figurative language development.

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Down Syndrome

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Differences in craniofacial structure lead to more ear infection and wax buildup. Children with DS tend to show poorer linguistic ability overall than children with similar mental ages but differing etiologies. Delays in expressive syntactic development exceed delays in lexical acquisition. Function words and verbs are more likely to be omitted when compared to children with similar MLUs.

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Fragile X Syndrome

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More prevalent in boys than girls. ~25% are also diagnosed with autism. Language disturbances are characterized by delayed onset and development of lexical and grammatical development in addition to oral-motor impairments, difficulties with social language.

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Phonology

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The study of the sound system of language. Also encompasses the sounds that the language uses as well as the rules for their different combinations.

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Phoneme

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A contrasting sound of language.

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Phone

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An individual speech sound, the realization of a phoneme in a particular context.

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Phonotactic constraints

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The rules that tell us the various sequences that sounds can be placed in.

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Morpheme

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The smallest unit of meaning in a language.

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Free morpheme

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A morpheme that can stand alone. e.g. cat

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Bound morpheme

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A morpheme than cannot stand alone. e.g. plural "s"

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Allomorph

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Any one of the possible phonetic forms of a morpheme

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Vowels vs. Consonants

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Vowels: vocal tract relatively unobstructed so that air moves through smoothly. VF vibration is the only sound source.
Consonants: constricted vocal tract. Classified by: place, manner and voicing.

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Place of articulation

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Point or points where the upper and lower articulators come closest together.

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Manner of articulation

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How the speech sound is produced. Stop, fricative, affricates, nasals, liquids, glides.

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Voicing

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Presence or absence of vocal fold vibration during production.

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Cognant pair

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Two sounds that only differ by voicing. e.g. /p/ and /b/

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Minimal pair

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Pair of words that differ in meaning and whose sounds are the same for one phonetic segment of feature.

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Phonological Development

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Infants can discriminate:
Sounds in their native language over other sounds and their parent’s voice over other voices within a week of life.
Place and manner of articulation and contrasting intonational patterns by 3 months of age.

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Cluster reduction

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Drop the more complicated sound in the cluster. e.g spider --> pider.

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Final consonant deletion

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dog --> da

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Assimilation

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Changes the n to m to sound more like b. e.g. green beans --> geem beans.

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Fronting

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Back sounds become front. k --> t, g --> d.

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Backing

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Much less typical. Front sounds become back. e.g. d --> g

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Stopping

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Sounds become stops. e.g. soup --> toup

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Gliding

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Liquid sounds are changed to gildes. green --> gween

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Phonological development by 3 years of age

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Most children can produce all vowel sounds, nearly all consonant sounds, but all the sounds might not be produced correctly in all contexts.

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Phonological development by 4-5 years of age

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Many children continue to misarticulate the liquid sounds and the fricatives /f/, /v/ and the voiced/voiceless /th/.

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Phonological development by 8 years of age

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Correct production of all sounds is achieved by most children.

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Parental role in phonological development

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Parents tend to unconsciously increase their own articulatory precision when talking with young children. Overt correction of misarticulations have limited success.

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Phonological awareness

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A form of metalinguistic knowledge that includes the ability to recognize the sounds of language and talk about them. Develops between 3 to 8 years of age. Early behaviors consist of “verbal play (e.g., rhyming games and nonsense words). Later behaviors consist of the ability to ID the 1st sounds in a word, correct segmentation of words into smaller units, blending sounds to form words, etc.

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Articulation Disorders

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Difficulty producing speech sounds and speech sound sequences.

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Phonological Disorders

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Difficulty understanding and implementing the language conventions for producing speech sounds and speech sound sequences.

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Intelligibility

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The "understandability" of spontaneous speech.

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How are articulation abilities evaluated?

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Using structured probes that include all the sounds in the language of interest. e.g. Goldman-Fristoe Test of Articulation.

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Articulation errors can be classified as

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Substitutions, omissions and distortions.

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Common etiologies of speech disorders

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Perceptual etiologies e.g. SNHL
Structural etiologies e.g. cleft palate
Motor etiologies e.g. dysarthria (neuro-muscular impairment), apraxia (neurologic impairment).

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Dysarthria

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A speech disorder caused by neuromuscular dysfunction that affects all aspects of speech production: respiration, phonation, resonance and articulation. Associated with cerebral palsy, Parkinson's disease, Huntington's disease, ALS, MS, cerebellar problems, ect.

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Apraxia

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A speech disorder where the difficulty lies in the ability to say things correctly and consistently. Developmental apraxia of speech (lots of debate on this). Acquired apraxia of speech (stroke, TBI ect.).

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Dysfluency

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Term used to describe speech that is marked by repetitions, interjections, pauses and revisions. e.g. stuttering

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Stuttering

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A fluency disorder described as having: an unusually high frequency or duration of repetitions, prolongations, and/or blockages that interrupt the flow of speech, interruptions are combined with excessive mental and physical effort to resume talking, causing negative perceptions of their communication abilities due to their inability to say what they want to say.

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Primary and secondary stuttering behaviors

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Primary: core behaviors such as repetitions, prolongations, and blocks (silent prolongations).
Secondary: counterproductive adaptations that are made to try to get through the primary stuttering behaviors or avoid them all together. Behaviors can consist of blinking eyes, opening the jaw, pursing lips, changing words or inserting "uh" before the word they anticipate stuttering on.

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Evaluation of stuttering

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Consists of interview and case history and the analysis of speech samples.

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Therapy for stuttering

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Consists of fluency shaping techniques and stuttering modification therapy.

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Voice Disorders

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Characterized as an aphonia (no speech) or a dysphonia (abnormal speech). Can arise from: discrete and diffuse tissue changes, gross structural changes, neurogenic pathology, myopathic pathology, nonorganic problems. Evaluated through perceptual evaluation and through instrumental evaluation.

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Laryngectomy

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Surgical removal of the larynx as treatment for laryngeal cancer. Voice options for those who have had laryngectomy: artificial larynx, esophageal speech, tracheoesophageal speech.

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Culture

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A set of beliefs and assumptions shared by a group of people that guide how individual members think, act and interact on a daily basis. Language can reflect the cultural group to which one belongs.

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Socialization

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The process of learning how to interact with others.

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Acculturation

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The process of learning a second culture.

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Language Difference

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The home language is affecting the language of instruction. Need to test in both languages to tell if it is a difference or disorder.

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Second Language Acquisition

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Basic interpersonal communication skills: acquired in the first few years of learning a language.
Cognitive academic language proficiency: when you start thinking, dreaming ect in the second language.

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Dialect

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Variation of a language that is understood by all speakers of that language. These variations may include difference in sounds, vocabulary, and grammatical variations.

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Accent

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Dialectical variations of intonation, prosody and phonology.

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AAE

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African American English. Can be viewed as a dialect of Standard American English (SAE). Has roots in West African languages.

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Bilingualism

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An individual who uses an understands two languages.

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Simultaneous bilingualism

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When language acquisition occurs from an individual being exposed to two languages from birth.

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Sequential bilingualism

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When individuals learn a second language at school or as an adult.

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Code switching

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The alternating use of two languages at the word, phrase, and sentence level.

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Registers

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Different ways of talking in different situations.

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Language abilities in older adults

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Over the course of the normal aging process, phonology does not change but semantics do. Lexical development continues throughout the lifetime. Confrontation naming (recalling names of things) declines with age. Older adults perform similarly as young adults with similar educational backgrounds. Hearing and memory decline with age for vast majority of population.

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Discourse changes with aging

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Expressive language tends to be more elaborate with healthy aging for some purposes (e.g., story telling). However, declines are also seen in the syntactic complexity with normal aging.

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Cognitive factors that change with age

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Declines in the speed of precessing, inhibition, and working memory are also seen with normal aging.

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Four causes of brain damage

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Head injury
Infections & growths
Progressive deterioration
Stroke

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Two classifications of head injuries

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Closed head injury can cause a contusion, which results in a concussion.
Open head injury.
The greater the severity of the head injury, the more that motoric, cognitive and communication skills will be affected. Dependent on location and size of injury.

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Neoplasms

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Malignant or benign brain cancer. Take up space in the skull and destroy brain tissue.

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Progressive brain damage

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Many causes. PD, MS, ALS, AD ect.

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Two types of strokes

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Ischemic: lack of oxygen to the brain due the narrowing of arteries (thrombosis) or a traveling piece of something (embolis).
Hemorrhagic: blood in the brain.
Edema (swelling) and the reduction in blood flow is responsible for the acute symptoms.

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Aphasia

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The loss or impairment of language abilities due to brain damage. Characterized by deficits in naming, fluency, and auditory comprehension. Also characterized by hemiplegia (opposite limb weakness or paralysis) and homonymous hemianopsia (visual neglect).

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Broca's Aphasia

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Damage occurs in the left posterior-inferior frontal lobe. Characterized by non-fluent, effortful speech and agrammatism. Agrammatic language is also observed in writing. Auditory comprehension is relatively preserved, except when directions require comprehension of function words of the sentence is grammatically complex.

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Wernicke's Aphasia

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Damage occurs in the superior posterior temporal lobe. Characterized by deficits in auditory comprehension and fluent oral expression. Speech production has normal intonation and stress, but is filled with paraphasias and neologisms. Patients may have different levels of awareness regarding their comprehension difficulties and their "empty" speech.

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Conduction Aphasia

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Damage occurs in the arcuate fasciculus (connection between Wernicke's and Broca's aphasia). Characterized by impaired ability to "conduct" information from one part of the brain to the other. Results in an intact ability to comprehend and to produce spontaneous speech, but an inability to repeat what is heard.

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Global Aphasia

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The damage occurs in a large enough portion of the left hemisphere to encompass both the frontal and temporal lobe. Characterized by the non-fluent verbal expression, poor auditory comprehension, severely impaired naming, and difficulty repeating words and sentences.

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Anomic Aphasia

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Characterized by good production and comprehension, with poor naming abilities.

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Right Hemisphere Damage

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Pragmatic abilities affected. Ability to understand humor and indirect discourse is impaired. Intonation impaired.

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Dementia

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Alzheimer's Disease is most common, but there are many other forms of dementia. Progressive disease process involves memory, problem solving, and language abilities.