1. Copyright © 2008 Delmar. All rights reserved. Unit Four Articulation and Phonological Disorders

2. Copyright © 2008 Delmar. All rights reserved. Chapter 9 Anatomy and Physiology of the Articulatory System

3. Copyright © 2008 Delmar. All rights reserved. 3 Biological Function of the Mouth Eating Speech is an overlaid function

4. Copyright © 2008 Delmar. All rights reserved. 4 Anatomy and Physiology of the Articulatory System Facial bones and muscles Mandible Lips Hard and soft palate Tongue Dentition

5. Copyright © 2008 Delmar. All rights reserved. 5 Facial Bones Fontal bone Temporal bones Sphenoid bones Zygomatic bones Maxilla Mandible

6. Copyright © 2008 Delmar. All rights reserved. 6 Facial Muscles Buccinator Depressor labii inferioris Levator labii superioris Masseter Orbicularis oris Risorious Zygomatic major

7. Copyright © 2008 Delmar. All rights reserved. 7 Mandible Lower jaw Largest facial bone Important for allowing mouth to open and sounds to be amplified

8. Copyright © 2008 Delmar. All rights reserved. 8 Hard Palate Roof of the mouth Contact point for tongue to produce several sounds

9. Copyright © 2008 Delmar. All rights reserved. 9 Soft Palate When soft palate is raised to posterior pharyngeal wall –Voice is directed into the oral cavity –Articulators modify sounds to produce consonants and vowels

10. Copyright © 2008 Delmar. All rights reserved. 10 Lips Four movements involved in speech: –Opening –Closing –Protrusion –Retraction Important in producing several sounds: p, b, m, w, f, v

11. Copyright © 2008 Delmar. All rights reserved. 11 Tongue Three biological functions: –Taste –Movement of food while chewing –Movement of food for swallowing

12. Copyright © 2008 Delmar. All rights reserved. 12 Tongue Primary articulator Important in producing several sounds: –Voiced and unvoiced ‘th’; t and d; k and g –Voiced and unvoiced ‘sh’

13. Copyright © 2008 Delmar. All rights reserved. 13 Tongue Tie Known as ‘ankyloglossia’ Due to a restricted lingual frenum/frenulum Reduces ability of tongue tip to elevate

14. Copyright © 2008 Delmar. All rights reserved. 14 Muscles of the Tongue Eight pairs of muscles Extrinsic muscles Four pairs that help position the tongue Intrinsic muscles Four pairs that help shape the tongue

15. Copyright © 2008 Delmar. All rights reserved. 15 Intrinsic Muscles Superior longitudinal Inferior longitudinal Transverse Vertical

16. Copyright © 2008 Delmar. All rights reserved. 16 Extrinsic Muscles Genioglossus Styloglossus Hyoglossus Palatoglossus

17. Copyright © 2008 Delmar. All rights reserved. 17 Tongue Thrust Resting the tongue against inner surface of the front teeth or protruding tongue between the teeth

18. Copyright © 2008 Delmar. All rights reserved. 18 Dentition Primary teeth erupt between 6-9 months All 20 primary teeth have erupted by 18- 24 months 32 permanent teeth erupt between 6-13 years

19. Copyright © 2008 Delmar. All rights reserved. 19 Bruxing Compulsive, unconscious clenching and grinding of teeth Can wear down the edges of the teeth

20. Copyright © 2008 Delmar. All rights reserved. 20 Dental Occlusions Class I –Normal relationship Class II (overbite) –Upper incisors are considerably anterior to lower incisors Class III (underbite) –Upper incisors rest behind the lower incisors

21. Copyright © 2008 Delmar. All rights reserved. Chapter 10 General American English Sound System

22. Copyright © 2008 Delmar. All rights reserved. 22 Phonetics Study of speech sound production Study of symbols used to represent speech sounds

23. Copyright © 2008 Delmar. All rights reserved. 23 Phonology Study of the sound system and the rules governing sound combinations

24. Copyright © 2008 Delmar. All rights reserved. 24 International Phonetic Alphabet (IPA) An alphabet for writing the speech sounds of all languages

25. Copyright © 2008 Delmar. All rights reserved. 25 Dialects A form of speech and language used in a geographical area According to ASHA –No dialect is a disorder or pathological form of speech or language

26. Copyright © 2008 Delmar. All rights reserved. 26 Accents Speech pronunciation and inflections of nonnative speakers

27. Copyright © 2008 Delmar. All rights reserved. 27 Accent Modification Therapy Goals Reduce speech characteristics that affect intelligibility Add speech characteristics to make speech easier to understand

28. Copyright © 2008 Delmar. All rights reserved. 28 American English Phonemes Speech sound in a language distinct from other sounds in that language

29. Copyright © 2008 Delmar. All rights reserved. 29 Classification of American English Phonemes Place –Location in mouth of articulators Manner –Degree of narrowing Voice –Whether the vocal folds are vibrating or not

30. Copyright © 2008 Delmar. All rights reserved. 30 Place of Articulation Bilabial Labiodental Interdental Alveolar Palatal Velar Glottal

31. Copyright © 2008 Delmar. All rights reserved. 31 Vowels Described by placement of tongue during their production

32. Copyright © 2008 Delmar. All rights reserved. Chapter 11 Etiologies of Articulation, Phonological, and other Communication Disorders

33. Copyright © 2008 Delmar. All rights reserved. 33 Functional vs. Organic Disorders Functional –No known anatomical, physiological or neurological basis for a disorder Organic –An anatomical, physiological, or neurological cause for a disorder

34. Copyright © 2008 Delmar. All rights reserved. 34 Three Primary Etiologies of Communication Delays/Disorders Normal variation Environmental problems Physical impairments

35. Copyright © 2008 Delmar. All rights reserved. 35 Normal Variation Approximately 70 percent of children fall within the typical range Only a small number fall outside the typical range

36. Copyright © 2008 Delmar. All rights reserved. 36 Environmental Problems Prenatal environment Syndromes Maternal substance abuse Low birth weight and prematurity Perinatal and postnatal environment

37. Copyright © 2008 Delmar. All rights reserved. 37 Physical Impairments Traumatic brain injury Hearing impairment

38. Copyright © 2008 Delmar. All rights reserved. 38 Integration of Factors We cannot determine a single factor as a cause for most communication problems Most communication problems are multifactorial –In many cases, the cause is unknown

39. Copyright © 2008 Delmar. All rights reserved. Chapter 12 Articulation Disorders

40. Copyright © 2008 Delmar. All rights reserved. 40 Articulation Disorders Occur in 10 to15 percent of preschool children 75 to 85 percent also have language disorders

41. Copyright © 2008 Delmar. All rights reserved. 41 Articulation Disorder Difficulty with the articulation of speech sounds Implies a motor component to the disorder

42. Copyright © 2008 Delmar. All rights reserved. 42 Goals of the Assessment Describe development Determine if speech is sufficiently different from the norm Identify factors related to the disorder Plan treatment Prognosis Monitor changes over time

43. Copyright © 2008 Delmar. All rights reserved. 43 Assessment Protocol Case history Assessment of speech –Screening and articulation testing Oral exam Hearing and language assessment Diagnosis Written report

44. Copyright © 2008 Delmar. All rights reserved. 44 Analysis of Data Number of errors Types of errors: –Substitutions, omission, additions, distortions Consistency of errors

45. Copyright © 2008 Delmar. All rights reserved. 45 Stimulability Child’s ability to produce the correct sound after cueing by clinician Stimulability indicates a better prognosis for improvement in therapy

46. Copyright © 2008 Delmar. All rights reserved. 46 Articulation Therapy SLPs need to be three people in one: –Scientists –Humanists –Artists

47. Copyright © 2008 Delmar. All rights reserved. 47 Treatment Efficacy Studies demonstrate that speech therapy is effective in improving speech sound production and intelligibility

48. Copyright © 2008 Delmar. All rights reserved. 48 Traditional Therapy Approach Child is made aware of phoneme Child recognizes errors Child produces phoneme in isolation, syllables, words, phrases, sentences Carryover

49. Copyright © 2008 Delmar. All rights reserved. Chapter 13 Phonological Disorders

50. Copyright © 2008 Delmar. All rights reserved. 50 Phonology Study of the sound system of a language and the rules governing sound combinations

51. Copyright © 2008 Delmar. All rights reserved. 51 Phonological Disorder Difficulty with the acquisition of a rules underlying the sound system 80 percent of children with phonological disorders also have language disorders

52. Copyright © 2008 Delmar. All rights reserved. 52 Theories of Phonology Natural phonology Linear/generative phonology Nonlinear phonology

53. Copyright © 2008 Delmar. All rights reserved. 53 Principles of Phonological Assessment Transcribe the whole word Sample phonemes in a variety of contexts Always sample continuous speech Determine stimulability

54. Copyright © 2008 Delmar. All rights reserved. 54 Therapy Approaches Distinctive features Cycles approach Minimal contrasting pairs

55. Copyright © 2008 Delmar. All rights reserved. 55 Distinctive Features Approach Teach children to produce specific distinctive features Teach the rules for correct use of a distinctive feature

56. Copyright © 2008 Delmar. All rights reserved. 56 Cycles Approach Different phonological patterns are targeted in specific time periods called “cycles”

57. Copyright © 2008 Delmar. All rights reserved. 57 Minimal Contrasting Pairs Create pairs of words where one word has the correct phonological pattern and the other word has the contrasting pattern

58. Copyright © 2008 Delmar. All rights reserved. Chapter 14 Motor Speech Disorders

59. Copyright © 2008 Delmar. All rights reserved. 59 Childhood Apraxia of Speech (CAS) A motor speech disorder in the absence of muscle weakness Affects motor planning, sequencing, coordinating and initiating motor movements

60. Copyright © 2008 Delmar. All rights reserved. 60 Speech Characteristics of CAS More errors with complex sounds (fricatives, clusters) Errors increase with increasing length of utterance Omissions Vowel errors

61. Copyright © 2008 Delmar. All rights reserved. 61 Speech Characteristics of CAS Groping behavior Prosodic impairments Lack of progress with traditional articulation or phonological therapy

62. Copyright © 2008 Delmar. All rights reserved. 62 Assessment of CAS Case history Hearing screen Assessment of all speech systems Articulation testing Language testing

63. Copyright © 2008 Delmar. All rights reserved. 63 Therapy for CAS Intensive One-on-one Progress through a hierarchy of task difficulty Many repetitions Small increases in task difficulty Multiple modalities

64. Copyright © 2008 Delmar. All rights reserved. 64 Childhood Dysarthria A motor speech disorder caused by neurological damage prenatally, perinatally, or postnatally

65. Copyright © 2008 Delmar. All rights reserved. 65 Speech Characteristics of Childhood Dysarthria It can affect each speech system: –Respiration, phonation, resonation, articulation Will affect the range of motion, strength, coordination, and rate of movement

66. Copyright © 2008 Delmar. All rights reserved. 66 Assessment of Childhood Dysarthria All speech systems must be evaluated individually and in coordination with other systems

67. Copyright © 2008 Delmar. All rights reserved. 67 Therapy for Childhood Dysarthria Primary goal of therapy is to maximize speech intelligibility

68. Copyright © 2008 Delmar. All rights reserved. 68 Cerebral Palsy Most common cause of dysarthria in children Incidence is 1 in 500 children in developed countries

69. Copyright © 2008 Delmar. All rights reserved. 69 Types of Cerebral Palsy Children with too much muscle tone: –Hypertonicity Children with too little muscle tone: –Hypotonicity

70. Copyright © 2008 Delmar. All rights reserved. 70 Classification of Cerebral Palsy Spastic Athetoid Ataxic Mixed

71. Copyright © 2008 Delmar. All rights reserved. 71 Spastic Cerebral Palsy Most common type –60 to 70 percent Hypertonicity –Abrupt, jerky, labored movements

72. Copyright © 2008 Delmar. All rights reserved. 72 Athetoid Cerebral Palsy 20 to 30 percent of cases Slow, continuous, involuntary movements of extremities

73. Copyright © 2008 Delmar. All rights reserved. 73 Ataxic Cerebral Palsy 5 to10 percent of cases Hypotonicity Impaired ability to coordinate movements and maintain balance

74. Copyright © 2008 Delmar. All rights reserved. 74 Mixed Cerebral Palsy Combination of different types Spasticity and athetosis is most frequent combination

75. Copyright © 2008 Delmar. All rights reserved. 75 Cerebral Palsy: Speech/Language Moderate to severe unintelligibility Language and cognitive problems

76. Copyright © 2008 Delmar. All rights reserved. 76 Cerebral Palsy: Associated Problems Intellectual disabilities –75 percent of cases Hearing impairments

77. Copyright © 2008 Delmar. All rights reserved. 77 Cerebral Palsy: Associated Problems Visual impairment –71 percent of cases Seizure disorders –Occur in 45 percent of cases

78. Copyright © 2008 Delmar. All rights reserved. 78 Evaluation An interdisciplinary team is required Team will include SLP, OT, PT, and other professionals specially trained to work with children with cerebral palsy

79. Copyright © 2008 Delmar. All rights reserved. 79 Therapy Team approach is required PT is usually the lead team member PT can help with best posture/positions for the child to use in other therapy tasks

80. Copyright © 2008 Delmar. All rights reserved. Chapter 15 Emotional and Social Effects of Articulation and Phonological Disorders

81. Copyright © 2008 Delmar. All rights reserved. 81 Educational Effects Children may not speak in class Avoid peer interactions Seventy-five to eighty-five percent of preschoolers and 50% to 70% of school-age children also have language disorders

82. Copyright © 2008 Delmar. All rights reserved. 82 Speech Characteristics Two speech characteristics that attract the most negative attention –Conspicuousness of the disorder –Degree of unintelligibility There are many overt and covert ‘penalties’ associated with impaired articulation

83. Copyright © 2008 Delmar. All rights reserved. 83 Articulation and Phonological Disorders Children with articulation and/or phonological disorders may be teased because of their speech These children may develop negative attitudes about themselves

84. Copyright © 2008 Delmar. All rights reserved. 84 Articulation and Phonological Disorders Children may be frustrated if they cannot be understood by others Many children may choose to remain silent rather than talk Parents report their children have difficulties with social competence