Speech Disorders. Speech Disorders II.Speech disorders: 1. Dyslalia (Misarticulation): Definition: Faulty articulation of one or more of speech sounds.

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Presentation transcript:

Speech Disorders

II.Speech disorders: 1. Dyslalia (Misarticulation): Definition: Faulty articulation of one or more of speech sounds not appropriate for age.

Types of dyslalia: A) Sigmatism (/s/ defect):- - Interdental sigmatism. - Lateral sigmatism. - Pharyngeal sigmatism. B) Back-to-front dyslalia:- /k/ /t/ /g/ /d/ C) Rotacism (/r/ defect). D) Voiced-to-nonvoiced dyslalia:- /g/ /k/ /d/ /t/ /z/ /s/ etc…

Diagnosis of dyslalia: History taking. Physical examination: … , tongue, … Investigations: - Audio recording. - Articulation test. - Psychometry (IQ). - Audiometry. Dyslalia Sheet

Management of dyslalia: Treatment of the cause: . Tongue tie. . Dental anomalies. Speech therapy.

II.Speech disorders: 2. Stuttering: Definition: The intraphonemic disruptions resulting in sound and syllable repetitions, sound prolongations, and blocks.

Normal dysfluency: - Less than 6 years. - Only repetitions. - No associated muscular activity. - Not aware.

Incidence of stuttering: 1%. Onset: - Earliest = 18 months. - Latest = 13 years. Epidemiology: - more in families with history of stuttering. - can occur in mentally retarded. - very rare in the hearing impaired.

Gender ratio: 4 : 1 (male : female) Theories of Stuttering: The exact cause is unknown. - Organic theory. - Neurosis theory. - Learning theory.

Diagnosis of stuttering: History taking. Physical examination: APA, VPA, … Investigations: - Audio and video recording. - Stuttering severity (eg SSI). - Articulation test. - Psychometry (IQ). Stuttering Sheet

Auditory Perceptual Analysis (APA): A. Core behaviors: - Intraphonemic disruption. - Repetitions. - Prolongations. - Blocks. B. Secondary reactions: - Muscular activity and struggle. - Interjection. - Word substitutions and circumlocution. C. Concomitant reactions: - Fear. - Breathing (antagonism, interruption, prolongation, cessation, …). - Eye contact. - Skin pallor/flushing.

Management of stuttering: Family and patient counseling. Speech therapy: a. Indirect therapy: if not aware. b. Direct therapy: if aware.

II.Speech disorders: 3. Hypernasality: Definition: Faulty contamination of the speech signal by the addition of nasal noise. It results from velopharyngeal insufficiency (VPI).

Causes of hypernasality: I. Organic: 1.Structural: a) Congenital: - Overt cleft palate. - Submucous cleft palate. - Non-cleft causes: . Congenital short palate. . Congenital deep pharynx. b) Acquired: - Adenotonsillectomy. - Palatal trauma. - Tumors of the palate & pharynx. 2. Neurogenic: - Palatal upper motor neuron lesion. - Palatal lower motor neuron lesion.

Causes of hypernasality (cont.): II. Non-organic (Functional): - Faulty speech habits. - Mental retardation. - Neurosis or hysteria. - Hearing impairment. - Post-tonsillectomy pain.

Effects of VPI: - Feeding problems: nasal regurgitation. - Ear infections (tensor palati: V). - Psychosocial problems. - Communicative problems: . Speech: hypernasality. . Language: DLD. . Voice: hyper or hypofunction.

Diagnosis of hypernasality: I. History taking. II. Physical examination: - General. - ENT examination: …, palate (inspection, palpation) ... - Simple tests: . Gutzman’s (a/i) test. . Czermak’s (cold mirror) test. III. Investigations: - Audio recording. - Fiberoptic nasopharyngolaryngoscopy. - Psychometry (IQ). - Audiometry. - Articulation test. - Nasometry. Hypernasality Sheet

Management of hypernasality: - Team work. - Feeding. - Hearing. - Maxillofacial. - Palatal and lip surgeries. - Obturators. - Communication: . Language: Language therapy. . Speech: Speech therapy. . Voice: Voice therapy.

II.Speech disorders: 4. Dysarthria: Definition: Any combination of disorders of respiration, phonation, articulation, resonance, and prosody, that may result from a neuromuscular disorder.

Types of dysarthria: 1. Flaccid dysarthria: - Lesion: lower motor neuron level. - Communication: * breathy phonation. * hypernasality. 2. Spastic dysarthria: - Lesion: upper motor neuron level. * strained strangled phonation. * labored breathing.

Types of dysarthria (cont.): 3. Ataxic dysarthria: - Lesion: cerebellum level. - Communication: * increased equal stresses. * irregular articulatory breakdown.

Types of dysarthria (cont.): 4. Dyskinetic dysarthria: - Lesion: basal ganglia level. A. Hypokinetic type (Parkinsonism): * breathy phonation. * rapid rate. * short rushes of speech with final decay. B. Hyperkinetic type: i. Quick hyperkinetic (Chorea): * variable rate and loudness. ii. Slow hyperkinetic (Athetosis): * slow rate.

Types of dysarthria (cont.): 5. Mixed dysarthria: - may the most common. - Examples: * Motor neuron disease .…Flaccid + Spastic. * Multiple sclerosis ……... Ataxic + Spastic. * Wilson’s disease ………. Ataxic + Spastic + Hypokinetic.

Diagnosis of dysarthria: History taking. Physical examination: … , mouth, palate, … , neurological exam, … Investigations: - Audio recording. - Fiberoptic nasopharyngolaryngoscopy. - CT/MRI brain - Dysphasia test. - Psychometry (IQ). - Articulation test. - Audiometry. - Nasometry. - MDVP. - Aerodynamics (Aerophone II). Dysarthria Sheet

Management of dysarthria: Individualized: Management of the cause. Patient counseling. Communicative therapy: * Articulation. * Phonation. * Resonance. * Respiration. * Prosody. Alternative and augmentative communication.