Fluency disorders Stuttering Neurogenic disfluency stroke, head trauma, dementia, tumors, drug usage extrapyramidal diseases Psychogenic disfluency Spasmodic dysphonia (spastic) Tourette syndrome Linguistic disfluency Normal developmental disfluency

Stuttering Onset characteristics – two stages (Bluemel) Primary stuttering Easy, intermittent repetitions of the first word or syllable in a sentence Secondary stuttering - progression Clonic types – more rapid, tense behaviors involving muscle tension, interrupted breathing and facial tension Tonic types

Stuttering Fluency disorder Stuttering varies by time, situation, and language factors Special conditions that immediately eliminate stuttering: Choral reading – with a speaker who is fluent Lipped speech, whispered speech Prolonged speech with or without Delayed Auditory Feedback Rhytmic speech, shadowing Singing Slowed speech

Stuttering Etiology – multifactorial As the interaction of predisposing factors Negative emotional responses The incomplete cerebral dominance theory Consequences of a brain lesion Therapy – treatment Family based treatment Speech treatment – relationship to age (school-age, adolescents, adults) Psychotherapy, relaxation….

Gender - Relatives Porucha plynulosti U ženských příbuzných mužských příbuzných Celkem Zastoupení pohlaví ženskémužskéCelkem poměr 1 :5

Cleft lip and palate Cleft palate disorders Birth defect (prevalence 1/ ) – a lack of continuity of structure of some of various segments which normally combine to form the upper lip and palate (the roof of the mouth) – those structures are deficient ¼ cleft lip only, ½ cleft lip and palate, ¼ cleft palate In any event there is an open passageway connecting the mouth cavity and the nose Velopharyngeal incompetence Feeding problems, respiratory infections, Dental and occlusal problems

Cleft palate – communication problems Hearing impairment – conductive, middle ear disease Language development - may be slower in the beginning of to talk Speech-sound articulation Voice quality Velopharyngeal incompetence and its effects on speech: inability to close the velopharyngeal port Palatolalia, palatophonia – hyperrhinophonia

Broca´s Aphasia Nonfluent, halting verbal output Incomplete and syntactically simplified sentences Reduced phrase lenght, prosodic disturbance Awkward articulation Concomitant apraxia of speech Agramatism is a common X auditory comprehension is relatively O.K. Repetition is possible Frontal lobe demage, the posterior-inferior frontal gyrus of the left cerebral hemisphere

Wernickeś Aphasia Defective auditory comprehension Fluent paraphasic speech Defective repetition of words and sentences Both reading and writing usually disturbed Infrequent hemiparesis Result of injury to the post region of the left superior temporal gyrus