Articulation and Phonological Disorders Continued Assessment Steps Describe articulation status usually formal tests Assess stimulability ability to produce sounds correctly when given careful instructions Identify etiology Consider overall intelligibility often a Consider developmental status age Make progress more later Description of Sound Errors S substitution wun for run wadon for wagon O omissions hou for house pane for plane D Distortion sound close to correct but not quite right thoup for soup fingo for finger bood for bird A addition not as common balue for blue Prognosis prediction of rate of recovery Prognosis is better if o Client is stimulable to make the sound they may learn it quickly o Client s errors are inconsistent means production isn t a true habit yet o Client can hear errors and self correct means they know the difference b w error and correct production Traditional Articulation Therapy Typically four stages o Ear training getting child to hear sound and recognize their error o Production training teach sound 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 Articulation therapy which sounds do you target Goal increase speech intelligibility First consider developmental sequence you don t train a sound that a child wouldn t have by that age They 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 w in the language Phonological Based Therapy Find he pattern of errors rather than individual sounds Teach RULES not SOUNDS Ex Child leaves off ALL final consonants Instead of teaching each sound that could occur at the end of a word teach child the rule will ALL consonants Much more efficient works best w kids w many sound errors Lots of kids leave off final consonant cat to ca dog to do Generalization and Maintenance Incorrect production of sounds is a habit that has to be broken Clefts Child has to make sounds correctly in more places than just therapy room w people other than therapist May have to do therapy outside of therapy room to a make sure child can make sounds in all environments Follow up after dismissal to assess maintenance Cleft Lip and Palate Clefts general term for abnormal openings in anatomical structures Clefts of the lip and or palate vary in severity and placement Fetal Development of the Face and Palate Facial development o Structures of the upper face form in the 5th 12th week of gestation o Hard and soft palate fusion occurs in 8th 12th week of gestation When the structures do not grow to the right size at the right time to meet and fuse When the fusion of these structures is not complete Palatal development How does cleft palate happen together Cleft Lip Cleft lip alone Incomplete minor V shaped notch in red lip border vermilion o o Complete separation of upper lip tissue into the nose Unilateral Cleft of the 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 of the 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 Hints bifid 2 part W shaped uvula bluish color in center of soft palate Symptom hypernasal speech Incidents of Clefts One of every 600 to 750 births About 6 800 births in the US each year Clefts occur in 2 1 in males In the US americans Etiology Exact etiology unknown and complex Most are genetic simple or syndromes Parents w o clefts 3 5 chance o Asian americans highest incidence o Then native americans caucasians and lowest incidence in african o One child w cleft 5 chance of another May be environmental cause vitamin B deficiency maternal alcohol consumption mothers over the age of 35 years old smoking Complications of Cleft Palate Feeding Hearing problems Hearing Problems o Needs adaptive bottles and nipples etc At risk for aspiration food and liquids going into the lungs May develop aversion to eating Psycho social development pictures in baby book treat like normal kid Speech problems voice resonance and articulation High incidence of middle ear disease Hearing loss is usually die to poor Eustachian tube functioning causing Otitis media Routine testing every 3 to 6 months Contributes to poor speech and long development Resonance Disorders Hypernasal speech o Caused by Velopharyngeal Incompetence VPI o Short palate Voice Disorders o Bilateral vocal nodules is most common problem o Attempt to use vocal cords to close off oral from basal cavity Articulation Problems Typical articulation errors o Glottal stops for oral stops o Pharyngeal fricatives for oral fricatives o Basal air escapes on fricatives and stops o Additional patterns of compensatory articulation which may be difficult to change Language Delay Children w clefts higher incidence of language delay Possible reasons o Hearing problems otitis media o Decreased language stimulation Increased time in hospital o Encourage early speech AND language evaluations The Cleft Palate Team Complicated condition Needs many professionals and appropriate timing for treatment Key professions include SLP Surgeons plastic ENT o o Dental specialists orthodontists endodentitsts o o Audiologist o o Geneticist Speech Language Therapy Social worker case worker 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 o Make recommendations for prosthetic devices and possible later surgery to right correct VPI