Articulation and Phonological Disorders ContinuedAssessment 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 quicklyo Client’s errors are inconsistent- means production isn’t a true habit yeto Client can hear errors and self-correct- means they know the difference b/w error and correct productionTraditional Articulation Therapy- Typically four stageso Ear training – getting child to hear sound and recognize their erroro Production training- teach sound in gradually increasing length of occurrence: isolation, syllables, words, phrases, sentenceso Stabilization- reinforcement and reviewo Transfer or generalization- producing new sound outside of therapy Best for improving a few sound errorsArticulation 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 languagePhonological 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 the9rule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- Child has to make sounds correctly in more places than just therapy room w/ peopleother 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 maintenance9Cleft Lip and PalateClefts- Clefts - general term for abnormal openings in anatomical structures- Clefts of the lip and/or palate vary in severity and placementFetal Development of the Face and Palate- Facial development9o Structures of the upper face form in the 5th9- 12th9week of gestation- Palatal developmento Hard and soft palate fusion occurs in 8th9- 12th9week of gestationHow does cleft palate happen?- When the structures do not grow to the right size at the right time to meet and fuse together- When the fusion of these structures is not completeCleft Lip- Cleft lip alone:o Incomplete - minor ‘V’ shaped notch in red lip border (vermilion)o Complete - separation of upper lip tissue into the noseUnilateral 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 deformityBilateral 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 separatedSubmucous 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 palateIncidents 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:o Asian americans - highest incidenceo Then native americans, caucasians and lowest incidence in african americansEtiology- Exact etiology unknown and complex- Most are genetic (simple or syndromes)- Parents w/o clefts - 3.5% chanceo 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, smokingComplications of Cleft Palate- Feedingo 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- Hearing problemsHearing Problems- 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 developmentResonance Disorders- Hypernasal speech:o Caused by Velopharyngeal Incompetence (VPI)o Short palate- Voice Disorderso Bilateral vocal nodules is most common problemo Attempt to use vocal cords to close off oral from basal cavityArticulation Problems- Typical articulation errors:o Glottal stops for oral stopso Pharyngeal fricatives for oral fricativeso Basal air escapes on fricatives and stopso Additional patterns of9compensatory articulation which may be difficult to changeLanguage Delay- Children w/ clefts = higher incidence of language delay- Possible reasons:o Hearing problems (otitis media)o Decreased language stimulationo Increased time in hospital- Encourage early speech AND language evaluationsThe Cleft Palate Team- Complicated condition- Needs many professionals and appropriate timing for treatment- Key professions include:o Surgeons (plastic, ENT)o Dental specialists (orthodontists, endodentitsts)o SLPo Audiologisto Social worker/case workero GeneticistSpeech-Language Therapy- Goal: have as normal development as possible considering physical differenceso Early language stimulationo Prevention of compensatory speech sound habitso Teaching correct positioning for sounds even if they don’t sound exactly righto Make recommendations for: prosthetic devices and possible later surgery to correct