copyright © 2008 delmar. all rights reserved. unit four articulation and phonological disorders
TRANSCRIPT
Copyright © 2008 Delmar. All rights reserved.
Unit Four
Articulation and
Phonological Disorders
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Chapter 9
Anatomy and Physiology
of the Articulatory System
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3
Biological Function of the Mouth
• Eating
• Speech is an overlaid function
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4
Anatomy and Physiology of the Articulatory System
• Facial bones and muscles
• Mandible
• Lips
• Hard and soft palate
• Tongue
• Dentition
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5
Facial Bones
• Fontal bone
• Temporal bones
• Sphenoid bones
• Zygomatic bones
• Maxilla
• Mandible
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6
Facial Muscles
• Buccinator
• Depressor labii inferioris
• Levator labii superioris
• Masseter
• Orbicularis oris
• Risorious
• Zygomatic major
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7
Mandible
• Lower jaw
• Largest facial bone
• Important for allowing mouth to open and sounds to be amplified
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8
Hard Palate
• Roof of the mouth
• Contact point for tongue to produce several sounds
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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
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10
Lips
• Four movements involved in speech:– Opening– Closing– Protrusion– Retraction
• Important in producing several sounds: p, b, m, w, f, v
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11
Tongue
• Three biological functions: – Taste– Movement of food while chewing– Movement of food for swallowing
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12
Tongue
• Primary articulator
• Important in producing several sounds:– Voiced and unvoiced ‘th’; t and d; k and g– Voiced and unvoiced ‘sh’
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13
Tongue Tie
• Known as ‘ankyloglossia’
• Due to a restricted lingual frenum/frenulum
• Reduces ability of tongue tip to elevate
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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
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15
Intrinsic Muscles
• Superior longitudinal
• Inferior longitudinal
• Transverse
• Vertical
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16
Extrinsic Muscles
• Genioglossus
• Styloglossus
• Hyoglossus
• Palatoglossus
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17
Tongue Thrust
• Resting the tongue against inner surface of the front teeth or protruding tongue between the teeth
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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
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19
Bruxing
• Compulsive, unconscious clenching and grinding of teeth
• Can wear down the edges of the teeth
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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
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Chapter 10
General American
English Sound System
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22
Phonetics
• Study of speech sound production
• Study of symbols used to represent speech sounds
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23
Phonology
• Study of the sound system and the rules governing sound combinations
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24
International Phonetic Alphabet (IPA)
• An alphabet for writing the speech sounds of all languages
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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
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26
Accents
• Speech pronunciation and inflections of nonnative speakers
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27
Accent Modification Therapy Goals
• Reduce speech characteristics that affect intelligibility
• Add speech characteristics to make speech easier to understand
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28
American English Phonemes
• Speech sound in a language distinct from other sounds in that language
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Classification of American English Phonemes
• Place– Location in mouth of articulators
• Manner– Degree of narrowing
• Voice– Whether the vocal folds are vibrating or not
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Place of Articulation
• Bilabial
• Labiodental
• Interdental
• Alveolar
• Palatal
• Velar
• Glottal
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31
Vowels
• Described by placement of tongue during their production
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Chapter 11
Etiologies of
Articulation, Phonological,
and other Communication
Disorders
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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
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34
Three Primary Etiologies of Communication Delays/Disorders
• Normal variation
• Environmental problems
• Physical impairments
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35
Normal Variation
• Approximately 70 percent of children fall within the typical range
• Only a small number fall outside the typical range
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36
Environmental Problems
• Prenatal environment
• Syndromes
• Maternal substance abuse
• Low birth weight and prematurity
• Perinatal and postnatal environment
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37
Physical Impairments
• Traumatic brain injury
• Hearing impairment
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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
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Chapter 12
Articulation Disorders
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40
Articulation Disorders
• Occur in 10 to15 percent of preschool children
• 75 to 85 percent also have language disorders
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Articulation Disorder
• Difficulty with the articulation of speech sounds
• Implies a motor component to the disorder
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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
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43
Assessment Protocol
• Case history
• Assessment of speech– Screening and articulation testing
• Oral exam
• Hearing and language assessment
• Diagnosis
• Written report
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44
Analysis of Data
• Number of errors
• Types of errors:– Substitutions, omission, additions,
distortions
• Consistency of errors
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45
Stimulability
• Child’s ability to produce the correct sound after cueing by clinician
• Stimulability indicates a better prognosis for improvement in therapy
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46
Articulation Therapy
• SLPs need to be three people in one:– Scientists– Humanists– Artists
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47
Treatment Efficacy
• Studies demonstrate that speech therapy is effective in improving speech sound production and intelligibility
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48
Traditional Therapy Approach
• Child is made aware of phoneme
• Child recognizes errors
• Child produces phoneme in isolation, syllables, words, phrases, sentences
• Carryover
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Chapter 13
Phonological Disorders
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50
Phonology
• Study of the sound system of a language and the rules governing sound combinations
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Phonological Disorder
• Difficulty with the acquisition of a rules underlying the sound system
• 80 percent of children with phonological disorders also have language disorders
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52
Theories of Phonology
• Natural phonology
• Linear/generative phonology
• Nonlinear phonology
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53
Principles of Phonological Assessment
• Transcribe the whole word
• Sample phonemes in a variety of contexts
• Always sample continuous speech
• Determine stimulability
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54
Therapy Approaches
• Distinctive features
• Cycles approach
• Minimal contrasting pairs
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55
Distinctive Features Approach
• Teach children to produce specific distinctive features
• Teach the rules for correct use of a distinctive feature
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56
Cycles Approach
• Different phonological patterns are targeted in specific time periods called “cycles”
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Minimal Contrasting Pairs
• Create pairs of words where one word has the correct phonological pattern and the other word has the contrasting pattern
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Chapter 14
Motor
Speech Disorders
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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
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Speech Characteristics of CAS
• More errors with complex sounds (fricatives, clusters)
• Errors increase with increasing length of utterance
• Omissions
• Vowel errors
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Speech Characteristics of CAS
• Groping behavior
• Prosodic impairments
• Lack of progress with traditional articulation or phonological therapy
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Assessment of CAS
• Case history
• Hearing screen
• Assessment of all speech systems
• Articulation testing
• Language testing
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63
Therapy for CAS
• Intensive
• One-on-one
• Progress through a hierarchy of task difficulty
• Many repetitions
• Small increases in task difficulty
• Multiple modalities
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64
Childhood Dysarthria
• A motor speech disorder caused by neurological damage prenatally, perinatally, or postnatally
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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
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66
Assessment of Childhood Dysarthria
• All speech systems must be evaluated individually and in coordination with other systems
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67
Therapy for Childhood Dysarthria
• Primary goal of therapy is to maximize speech intelligibility
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68
Cerebral Palsy
• Most common cause of dysarthria in children
• Incidence is 1 in 500 children in developed countries
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Types of Cerebral Palsy
• Children with too much muscle tone: – Hypertonicity
• Children with too little muscle tone:– Hypotonicity
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Classification of Cerebral Palsy
• Spastic
• Athetoid
• Ataxic
• Mixed
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Spastic Cerebral Palsy
• Most common type– 60 to 70 percent
• Hypertonicity– Abrupt, jerky, labored movements
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Athetoid Cerebral Palsy
• 20 to 30 percent of cases
• Slow, continuous, involuntary movements of extremities
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Ataxic Cerebral Palsy
• 5 to10 percent of cases
• Hypotonicity
• Impaired ability to coordinate movements and maintain balance
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Mixed Cerebral Palsy
• Combination of different types
• Spasticity and athetosis is most frequent combination
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Cerebral Palsy: Speech/Language
• Moderate to severe unintelligibility
• Language and cognitive problems
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76
Cerebral Palsy: Associated Problems
• Intellectual disabilities – 75 percent of cases
• Hearing impairments
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77
Cerebral Palsy: Associated Problems
• Visual impairment – 71 percent of cases
• Seizure disorders – Occur in 45 percent of cases
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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
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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
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Chapter 15
Emotional and Social
Effects of Articulation
and Phonological Disorders
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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
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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
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83
Articulation andPhonological Disorders
• Children with articulation and/or phonological disorders may be teased because of their speech
• These children may develop negative attitudes about themselves
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84
Articulation andPhonological 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