Phonation vs. articulation disordersPhonological disordersPart of language that involves rules and patterns for the use of soundsInvolve children not learning the rules or patterns of sound useArticulation disordersProblems with the actual production of speech soundsThey know the rule, they just can’t do itSpeech and sound developmentChildren learn sounds in a fairly predictable orderSingle sounds learned firstBlends (st) and sound combinations (ks) learned laterPartially dependent on fine motor developmentGirls have better articulation earlier than boysSound development chartLeft end is where 50% of kids are able to produce that soundRight end is where 90% of kids can produce that soundBilabial, some nasal, most in front of mouth, all easy/hardly use tongueP, m, h, n, w, b18 months – 3 yearsby age 8, most speech sounds are learnedsimple sounds are learned early, harder sounds learned laterPhonological developmentAll young children make typical errors in sound productionThey don’t know the rulesAs they get older, learn the rules, correct their sound productionsEx. Sound cluster reduction (sirral for squirrel) involves a rule - for all sound clustersFinal consonant deletion (hou for house) – for all final consonantsFronting (titty tat for kitty cat) using front sounds for all back soundsNormal for 3 year olds, but the errors should have dropped out by 5 years oldEtiologies for articulation disordersOrganic – a structural problem or physical reasonHearing impairmentAge at onset, degree and type of hearing loss affect nature of impairmentPeople who lose hearing later in life have less impaired speechHistory of otitis media (middle ear infection) are often a factorEven temporary interruptions can cause delays in articulation and in languageNeurological impairmentDysarthria: damage in brain or nerves controlling articulatorsPoor coordination, weakness, paralysisCerebral Palsy – at birthLater onset due to stroke, tumor, degenerative diseases (Parkinson’s disease)Sounds produced are imprecise or slurred (articulation)Cleft Lip and/or PalateCongenital (from birth)Cleft type and age at repair influence speechSounds requiring intra-oral pressure are most affected (stops, fricatives, affricatives)Because the structures are abnormal, kids learn to make sounds wrong and have to reteach themMinor variations in palate don’t affect articulationOther oral abnormalitiesLips: minor variations, not significantTeethOpen bite/ missing teeth – misarticulationsDentures/braces may cause /s/ distortions – patients usually learn to compensate quicklyTongueAnkyloglossia – literally tongue tieGlossectomy – affects fricatives and stops (removal of parts of tongue – usually for cancer)Functional – no identifiable cause, faulty learningMost fall in this categoryArticulation TherapyFour stagesEar training – getting child to hear sound and recognize their errorProduction training – teach sounds in gradually increasing length of occurrence: isolation, syllables, words, phrases, sentencesStabilization – reinforcement and reviewTransfer or generalization – producing new sound outside of therapyBest for improving a few sound errorsGoal: increase speech intelligibilityFirst consider developmental sequence – you don’t train a sound that child wouldn’t have by that age. Look at:Likelihood of success: easy of mastery, visibility for teaching, results of stimulability testingImportance of possible targets to clientFrequency of targets within the languagePhonological Based TherapyFind pattern of errors rather than individual soundsTeach 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 consonantsMuch more efficient – works best with kids with many sound errorsFetal Development of the Face and PalateFacial development – structures of the upper face form in 5th – 12th weeks of gestationPalatal development – hard and soft palate fusion occurs in 8th – 12th week of gestationHow 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 completeUnilateral Cleft lip and PalateExtends from upper lip, through the dental arch and soft palateNasal septum attaches to the larger of the 2 segments to cause nasal deformityBilateral Cleft lip and PalateMost severe due to large amount of tissue lossLip and dental arch are cleft under both nostrilsCauses free floating piece on maxillaPalate complexity separatedSubmucous cleftCleft in muscles of hard or soft palate that is covered with thin layer of mucosal tissueMay not be found until later in childhoodSymptom: hypernasal speechHints: bifid (2 part W) shaped uvula, bluish color in center of soft palatePossible Etiologies of cleft palateExact etiology unknown and complexMost are genetic (simple or syndromes)Parents without clefts – 3.5% chanceOne child with cleft – 5% chance of anotherMay be environmental cause: vitamin B deficiency, maternal alcohol consumption, mothers over age of 35 years old, smokingComplications of cleft palateFeedingNeeds adaptive bottles and nipples, etc.At risk for aspiration (food and liquids going into lungs)May develop aversion to eatingPsycho-social development (pictures in baby book, treat like normal kid)Speech problems: voice, resonance, and articulationResonanceHypernasal speechCaused by Velopharyngeal Incompetence (VPI)Short palateVoice disordersBilateral vocal nodules is most common problemAttempt to use vocal cords to close off oral from basal cavityLearned behavior can be difficult to placeArticulationGlottal stops for oral stopsPharyngeal fricatives for oral fricativesBasal air escapes on fricatives and stopsAdditional patterns of compensatory articulation which may be difficult to changeHearing problemsHigh incidence of middle ear diseaseHearing loss is usually due to poor Eustachian tube functioning causing Otitis mediaRoutine testing every 3 to 6 monthsContributes to poor speech and long developmentSpeech-language therapy for cleft lip and palate childrenGoal: have as normal development as possible considering physical differencesEarly language stimulationPrevention of compensatory speech sound habitsTeaching correct positioning for sounds even if they don’t sound exactly rightMake recommendations for: prosthetic devices, and possible later surgery to correct VPINormal DysfluencyAll normal
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