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

2. 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

3. 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

4. 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

5. 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

6. Oral Devices Electropalatography Glossometry
Video with Dr. Samuel Fletcher

7. 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

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

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

10. 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

11. 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

12. 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

13. 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)

14. 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

15. 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)

16. Vowel Space-Centralize Vowels

17. 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

18. “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

19. 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

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

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

22. 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

23. 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

24. 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

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