12 12 2010 Phonation vs articulation disorders Phonological disorders o Part of language that involves rules and patterns for the use of sounds o Involve children not learning the rules or patterns of sound use Articulation disorders o Problems with the actual production of speech sounds o They know the rule they just can t do it Speech and sound development Children learn sounds in a fairly predictable order Single sounds learned first Blends st and sound combinations ks learned later Partially dependent on fine motor development Girls have better articulation earlier than boys Sound development chart o Left end is where 50 of kids are able to produce that sound o Right end is where 90 of kids can produce that sound o Bilabial some nasal most in front of mouth all easy hardly use tongue P m h n w b 18 months 3 years o by age 8 most speech sounds are learned o simple sounds are learned early harder sounds learned later Phonological development All young children make typical errors in sound production o They don t know the rules As they get older learn the rules correct their sound productions o Ex Sound cluster reduction sirral for squirrel involves a rule for all sound clusters o Final consonant deletion hou for house for all final consonants o Fronting titty tat for kitty cat using front sounds for all back sounds Normal for 3 year olds but the errors should have dropped out by 5 years old Etiologies for articulation disorders Organic a structural problem or physical reason o Hearing impairment Age at onset degree and type of hearing loss affect nature of impairment People who lose hearing later in life have less impaired speech History of otitis media middle ear infection are often a factor Even temporary interruptions can cause delays in articulation and in language o Neurological impairment Dysarthria damage in brain or nerves controlling articulators Poor coordination weakness paralysis Cerebral Palsy at birth Later onset due to stroke tumor degenerative diseases Parkinson s disease o Cleft Lip and or Palate Sounds produced are imprecise or slurred articulation Congenital from birth Cleft type and age at repair influence speech Sounds requiring intra oral pressure are most affected stops Because the structures are abnormal kids learn to make sounds wrong fricatives affricatives and have to reteach them Minor variations in palate don t affect articulation o Other oral abnormalities Lips minor variations not significant Teeth Open bite missing teeth misarticulations Dentures braces may cause s distortions patients usually learn to compensate quickly Tongue Ankyloglossia literally tongue tie Glossectomy affects fricatives and stops removal of parts of tongue usually for cancer Functional no identifiable cause faulty learning o Most fall in this category Articulation Therapy Four stages o Ear training getting child to hear sound and recognize their error o Production training teach sounds in gradually increasing length of occurrence isolation syllables words phrases sentences o Stabilization reinforcement and review o Transfer or generalization producing new sound outside of therapy Best for improving a few sound errors Goal increase speech intelligibility First consider developmental sequence you don t train a sound that child wouldn t have by that age Look at o Likelihood of success easy of mastery visibility for teaching results of stimulability testing Importance of possible targets to client Frequency of targets within the language Phonological Based Therapy Find pattern of errors rather than individual sounds Teach RULES not SOUND ex Child leaves off all final consonants Instead of teaching each sound that could occur at end of a word teach child the rule with all consonants Much more efficient works best with kids with many sound errors Fetal Development of the Face and Palate Facial development structures of the upper face form in 5th 12th weeks of gestation Palatal development hard and soft palate fusion occurs in 8th 12th week of gestation How does a cleft palate happen When structures do not grow to the right size at the right time to meet and fuse together Fusion of these structures is not complete Unilateral Cleft lip and Palate Extends from upper lip through the dental arch and soft palate Nasal septum attaches to the larger of the 2 segments to cause nasal deformity Bilateral Cleft lip and Palate Most severe due to large amount of tissue loss Lip and dental arch are cleft under both nostrils Causes free floating piece on maxilla Palate complexity separated Submucous cleft Cleft in muscles of hard or soft palate that is covered with thin layer of mucosal tissue May not be found until later in childhood Symptom hypernasal speech Hints bifid 2 part W shaped uvula bluish color in center of soft palate Possible Etiologies of cleft palate Exact etiology unknown and complex Most are genetic simple or syndromes Parents without clefts 3 5 chance o One child with cleft 5 chance of another May be environmental cause vitamin B deficiency maternal alcohol consumption mothers over age of 35 years old smoking Complications of cleft palate Feeding o Needs adaptive bottles and nipples etc At risk for aspiration food and liquids going into lungs May develop aversion to eating Psycho social development pictures in baby book treat like normal kid Speech problems voice resonance and articulation o Resonance Hypernasal speech Caused by Velopharyngeal Incompetence VPI Short palate o Voice disorders Bilateral vocal nodules is most common problem Attempt to use vocal cords to close off oral from basal cavity Learned behavior can be difficult to place o Articulation Glottal stops for oral stops Pharyngeal fricatives for oral fricatives Basal air escapes on fricatives and stops Additional patterns of compensatory articulation which may be Hearing problems difficult to change o High incidence of middle ear disease o Hearing loss is usually due to poor Eustachian tube functioning causing Otitis media o Routine testing every 3 to 6 months o Contributes to poor speech and long development Speech language therapy for cleft lip and palate children Goal have as normal development as possible considering physical differences o Early language stimulation o Prevention of compensatory speech sound habits o Teaching correct positioning for sounds even if they don t sound exactly right o Make recommendations for prosthetic devices and possible later surgery to correct VPI Normal Dysfluency All