Clinical Applications of Articulation Therapy Chapter 4 Perry C. Hanavan, Au.D.

Cineradiography Ken Stevens x-ray film or fluoroscopy exam of tissues and deep structures of the body using X-ray imaging devices projects radiographic (X-ray) images in a movie-like sequence onto a monitor

Strain Gage Iowa Oral Performance Instrument (IOPI) used to objectively measure tongue and lip strength and endurance Also provides biofeedback for oral motor exercise In essence, a clinical strain gage

X-ray Microbeam Microbeam analyzes speech patterns by tracking small pellets placed on the subject’s tongue, teeth and nose Tracking accomplished by a very narrow x-ray beam passing through the subject area and detected by a sodium iodide crystal located behind the head Dense pellets block the x-rays from reaching the crystal Allows study of speech patterns in real time

Ultrasound Speech therapists using ultrasound imaging Ultrasound transducer held under chin to observe real-time images of tongue Images used to provide client and clinician with information about tongue position and configurations during production of speech sounds Address articulation of sounds /t, d, n, s, z, l, r, k, g/ and vowels

Oral Devices Electropalatography Glossometry Video with Dr. Samuel Fletcher

Palatometry Device with electrodes mounted on thin acrylic plate custom made to cover individual’s hard palate and upper teeth to measure tongue and palate contact patterns from electrodes

Electropalatography SmartPalate bio-feedback technology provides digital visualization of how tongue functions during speech production

Glossometry Computer-based optoelectronic instrument developed to measure, display, and guide changes in tongue height and shape during speech using LEDs.

Optopalatograph (OPG) Similar in principle to glossometer and similar in configuration of electropalatograph Uses optical fibers to relay light to and from palate Distance sensing achieved by measuring amount of light reflected from surface of tongue

MRI Primarily suitable for static production Attempted to acquire dynamic MRI image sequences, i.e. MRI "movies" One technique involves acquisition of single images from an utterance repeated over and over A new technique for magnetic resonance imaging (MRI) allows movements of joints and organs to be captured in real time

Electromagnetic Articulography See inside patients’ mouths to track speech movements Only about 40 in the world Holds promise as a therapy tool for people who have lost ability to speak Small sensors attached to thin wires placed inside mouth with magnified images of mouth movements appearing on screen Shows tongue position during speech production to help provide visual feedback

Source Filter Theory and Problems in Speech Production Source-filter - a way of conceptualizing problems of speech production Dysarthria/Apraxia—neurologic disorders with weak speech musculature Hearing loss—difficulty with relationship with acoustic input and speech production Phonological disorders—often phoneme perceptual problems Tracheotomy—larynx development, tongue movement Cleft Palate—velopharyngeal problems (resonance—nasality problems)

Dysarthria Neurological disorders with weak speech production "Slurred" speech Speaking softly or barely able to whisper Slow rate of speech Rapid speech rate with a "mumbling" quality Limited tongue, lip, and jaw movement Abnormal intonation (rhythm) when speaking Hoarseness, breathiness Drooling or poor control of saliva Chewing and swallowing difficulty Sample

Apraxia Condition in which the patient has difficulty sequencing the articulatory movements for speech Examples of different levels of severity in Childhood Apraxia of Speech (CAS)

Vowel Space-Centralize Vowels

Slope index Acoustic measure This parameter is measured in Hz per msec, is based on the relationship between the F2 transitions and place of articulation

“Deaf Speech” Individuals with congenital or pre-lingual hearing loss vs. post-lingual loss Loss of speech intelligibility Difficulty in segmental aspects of speech Difficulty in control of suprasegmental aspects of speech Difficulty co-articulating

Segmental Problems Most frequent errors in spoken language of deaf Vowel problems (tend to neutralize vowels) F1/F2/ charts shows marked limitations in both horizontal and vertical degree of tongue movements for vowels Consonant errors common—omissions and substitutions involving voicing and manner of artic Place of production errors common because of imprecise tongue position and reduced articulatory movement

Acoustic Analysis of Speech Alveolar and velar stops produced further back in the vocal tract than normal Provides clues for speech therapy

Suprasegmental Aspects Incorrect Fo in word and sentence production Not enough variation in Fo to differentiate between declarative vs. interrogative utterances Sample

Speech Therapy Emphasis Some programs put emphasis on speech in education process, others some, and yet others put none Maasen & Povel (1985) research showed improving segmental production caused 50% improvement in intelligibility with major increase resulting from correcting vowel production

Phonological Disorders Speech disorder known as an articulation disorder. Do not use some or all of the speech sounds expected for their age group. Phonological processes Children use alternative articulation or simpler articulatory gestures in place of the adult model May produce a /t/ for /k/ sound Sample

Tracheostomy Surgical procedure to create opening through neck into trachea  Developmental consequences in infants: Prevention of larynx from making developmental descent Which may limit movement of tongue Reduction in articulatory movements Alteration of resonance characteristics of speech Sample

Cleft Palate Congenital division in roof of mouth Resonance issues High incidence of conductive hearing loss (typically middle ear infections) Sample