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37 Cards in this Set
- Front
- Back
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Speech sound disorders
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• Difficulties with producing certain sounds (articulation), with the patterns of language (phonological), and/or with oral motor planning (apraxia)
• Can affect children and adults • Range in severity |
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Phonology
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• Study of how sounds are organized
• Study of sound system of a given language • Phonology is related to all other aspects of language (phonetics, pragmatics, morphology, syntax, semantics). |
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Phonological development
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• The way sounds are stored
• The way sounds are produced • The rules/processes that bridge the way the sounds are stored and the way they are produced |
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Phonological disorder (phonemic disorder)
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o Language disorder that affects speaker’s production/mental representation of speech sounds of target language.
o May affect way speech sound information is stored, represented mentally, accessed and retrieved • Cognitive – linguistic • Phonemic disorders • Reflect changes in meaning o Phonemic and phonetic disorders not mutually exclusive (can be mixed) |
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Delayed Phonological Development
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• Coexists with delayed language
• Restricted number of words and speech sounds • Normal intelligence • Differential diagnosis over time |
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Intervention in phonology
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• Comprehensive assessment
• Hypothesize the difficulty • Determine basic intervention goals • Determine specific goals • Determine goal attack strategy and procedures • Develop sub goals • Engage in ongoing assessment/probing |
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Articulation Disorders Article
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Attitudes of fourth and sixth graders towards peers with articulation errors. Tape show of children with mild artic errors, attitudes towards speaking ability, speaker as a peer, and speaker as teenager. More negative attitudes towards speakers with artic error
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Articulation disorder
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• A speech disorder that affects the individual’s ability to produce certain sounds (phonetic disorder)
• Cause may be underlying muscle weakness/dysarthria • Cause may also be unknown (functional articulation disorder) • Phonetic Disorders o Mild or residual errors • Generally involving liquids or sibilants • Little impact on intelligibility o Deviations in sound production can be associated with oral structural anomalies |
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Interventions for articulation disorders
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• Assess target sound production
• Assess stimulability • Individuals need to practice sounds many times during sessions o Goal for number of productions of target sounds per 30 minute session (150 productions) |
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Apraxia of Speech
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• Motor planning disorder (sensorimotor speech disorder)
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Apraxia of Speech Characteristics
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o Difficulty imitating speech sounds
o Difficulty imitating non-speech movement (oral apraxia) such as sticking out their tongue o Groping when trying to produce sounds o In severe cases, an inability to produce sound at all o Inconsistent errors o Slow rate of speech o Somewhat preserved ability to produce “automatic speech” (rote speech), such as greetings like “How are you?” |
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Apraxia of Speech Differential Diagnosis
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o Articulatory struggle
o Errors increase with length of stimuli words o Errors inconsistent |
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Apraxia Intervention
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o Begin with easy phonemes
o Begin in isolation and move to CV o Move to CVC, three times o String syllables together o Work on words with target phoneme in initial, medial then final word position o Repetition of two word phrases with phonemes o Sentence frames |
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Dysarthria
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• A motor speech disorder
• Associated with paralysis, paresis or incoordination, slowness or sensory loss of speech musculature • Generic label for group of disorders • Effects muscle groups involved in respiration, phonation, articulation and resonation • Damage may be peripheral or central nervous system |
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Dimensions of Dysarthria: Phonation
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o Pitch
• Pitch level • Pitch breaks • Monopitch • Voice tremor o Intensity • Monoloudness • Excess loudness variation • Loudness decay • Alternating loudness • Loudness (overall) o Quality • Harsh voice • Hoarse (wet) voice • Breathy voice (continuous) • Breathy voice (transient) • Strained/strangled voice • Voice stoppages |
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Dimensions of Dysarthria: Resonation
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• Hypernasality
• Hyponasality • Nasal emission |
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Dimensions of Dysarthria: Respiration
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• Forced inspiration/expiration
• Audible inspiration • Grunt at end of expiration |
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Dimensions of Dysarthria: Articulation
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• Imprecise consonants
• Phonemes prolonged • Irregular articulatory breakdown • Phonemes repeated • Vowels distorted • Intelligibility |
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Dimensions of Dysarthria: Prosody
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• Rate
• Phrases short • Increase of rate overall • Reduced stress • Variable rate • Intervals prolonged • Inappropriate silences • Short rushes of speech • Excess and equal stress |
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Principles of Therapy for Dysarthria
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• Compensation (compensatory strategies)
• Purposeful activity • Monitoring • Motivation • Interdisciplinary teaming • Positive attitude improves prognosis • Increase physiological support for speech by modifying abnormal posture, tone, strengths • Modify the five processes of speech production (respiration, phonation, resonation, articulation, prosody) for improved function • Use of augmentative devices when needed |
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Assessment of speech sound errors
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o Structure and function or oral mechanism
o Biological foundations of speech • Respiration • Phonation • Articulation o Cognitive/Linguistic status o Hearing status o Case history o Social – Emotional |
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Assessment of speech patterns
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• Phonetic inventory – all different sounds produced in two or more word positions
• Phonemic inventory – what child says for adult model • Phonological process Analysis / Pattern analysis • Estimate of speech intelligibility |
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Treatment approaches for speech sound disorders
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• Intensity can be increased by:
o Increasing number of sessions o Eliciting greater number of responses • Can be accomplished by using clickers/counters o Engaging students by keeping a fast pace and strong routine • Need to consider service delivery models: • Need to create the most efficient model based on individual clients and SLP roles/responsibilities o Group and individual services o Push-in services o Pull-out/”push away” services o Number of sessions per week/day o Itinerant services • i.e. 5 minute kids and speedy speech |
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Cycles Approach
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• derived from developmental phonology
• each cycle based on number of error patterns and stimulability • typically each error pattern is targeted from 2-5 hours per cycle • phoneme or cluster is targeted for one hour per week (one 60 minute session or two 30 minute sessions) • foci are processes, rules or classes of sounds • goal to increase intelligibility • work within context of phonemic contrasts, generally within whole word contexts • overexposure to structures • establish auditory – perceptual base • cycle: the time period required for a client to successfully focus for 2-3 hours on each of her/his basic deficient patterns o a different phoneme (cluster) within a pattern is targeted for about 60 min. each |
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Cycles Approach example
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• Cycle 1:
• Final consonant deletion, using /p, t, s, f/ • Cycle 2 • Velar fronting - k, g (initial word position) • Cycle 3: • Weak syllable deletion • Cycle 4 • S clusters - st, sp, sk, ks, ts |
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Cycles Approach: 7 underlying principles
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o Phonological acquisition is gradual
o Children whose hearing is normal acquire sound system by listening o Children associate kinesthetic and auditory sensations as they acquire new phonological patterns o Phonetic environments can facilitate or inhibit correct sound productions o Children tend to generalize new speech production skills to other targets o Based on phonological analysis children can be optimally challenged but also successful from beginning of treatment o Children actively involved in phonological acquisition |
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Cycles Approach Administration
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• Can be used in variety of settings (schools, private practice, hospitals)
• Child reviews picture cards from past session • SLP reads list of 20 new targets (approximately 30 seconds) using slight amplification • Production/practice activities with target error pattern (8-10 mins.) • Phonological awareness activity • SLP probes for target for next session (i.e. cluster that child produces the best/ assess all sounds in every position) • SLP reads list from beginning of session with slight amplification • Home program provided including listening list and picture cards for practice (recommended that this is practiced for two minutes everyday) |
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Complexity theory
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• Start with most difficult sounds and sound clusters, such as “scr” and “shr,” so the effects of therapy will trickle down to improve upon less complex sounds
• Teach sounds produced with 0% accuracy that are nonstimulable and later acquired • Based on info about sound classes and consonant clusters (i.e. clusters imply affricates but not vice versa) |
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Complexity Theory example
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o Child one: (3.2 years) treatment focused on tw_ clusters
o Child two:(3.1 years) treatment focused on affricte /ts/ o Post-test Results: o Child one: Produced 100% of treated cluster in non-treated words, 79% appeared to be generalized to other clusters, and child produced untreated affricates with 62% accuracy o Child Two: Produces 29% of affricates in untreated probe words and little to no generalization to affricates or clusters |
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Complexity theory administration
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• Teach sounds in 3 – 5 high frequency words
• Teach sounds that induce the greatest predictable generalization • Teach minimal pair contrasts that involve two new sounds with maximal and major class differences o Maximal oppositions o Obstruents (stops, fricatives, affricates) vs. sonorants (vowels, glides, nasals) |
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PROMPT Therapy
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• Used with both children and adults with variety of speech sound disorders such as:
o Apraxia, dysarthria, phonological impairments, and individuals with hearing impairments o System of treatment that aims to integrate motor, cognitive – linguistic, and pragmatic components of language o Based on pressure, touch, kinesthetic, and proprioceptive cues • SLP cues articulatory movement with hands • Helps individuals to “get a feel” for the movements o May begin with gesture movements o Use meaningful words when possible o Syllable sequence drills • Such as guduba-go to bed |
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Treatment considerations
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• Need to work on right skill with most intensity in order to obtain best results
• If intervention is effective but not efficient we reach the right goal much later. If is efficient but not effective reach wrong goal. |
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Articulation and phonological disorders in adulthood
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• Functional speech disorders can persist into adulthood
o Disorders source of stress for adults • Adults with functional speech disorders often have difficulty (distortions and/or substitutions) of one or two sounds, like /s/ and /z/ or just /r/ or just /l/ • Motivation plays role in prognosis for adults. When motivated, adults who receive therapy and practice can remediate these errors |
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Articulation and phonological disorders in adulthood: Treatment
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• Traditional therapy (moving through a hierarchy)
• Other approaches (biofeedback) • Need to consider affect of disorder on functional communication and client’s life circumstances |
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Apraxia Treatment
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• Treatment includes drill and practice and re-training motor patterns for correct production in syllables, sounds and in sequencing these into words
• pace and rate of speech • Therapy targets should be individualized to include: o Articulating vowel and consonant sounds o Speaking words varying in syllable length o Verbalizing common phrases o Articulating sentences ranging from easy to complex o Fluently engaging in spontaneous conversation o Using intonation and verbal inflection appropriately • Oral Motor exercises |
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Oral Motor exercises
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o Blowing bubbles
o Blowing harmonica o Using straw o Tongue press o Jaw isometrics o Brushing o Icing o Licking ice cream o Peanut butter on lips o Important that feedback incorporated into exercises (mirror) |
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Difference between apraxia and dysarthria?
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Apraxia = Motor planning disorder (sensorimotor speech disorder)
Dysarthria=A motor speech disorder • Associated with paralysis, paresis or incoordination, slowness or sensory loss of speech musculature |
