Copyright © 2008 Delmar. All rights reserved. Unit Four Articulation and Phonological Disorders.

Copyright © 2008 Delmar. All rights reserved.

Unit Four

Articulation and

Phonological Disorders


Chapter 9

Anatomy and Physiology

of the Articulatory System


3

Biological Function of the Mouth

• Eating

• Speech is an overlaid function


4

Anatomy and Physiology of the Articulatory System

• Facial bones and muscles

• Mandible

• Lips

• Hard and soft palate

• Tongue

• Dentition


5

Facial Bones

• Fontal bone

• Temporal bones

• Sphenoid bones

• Zygomatic bones

• Maxilla

• Mandible


6

Facial Muscles

• Buccinator

• Depressor labii inferioris

• Levator labii superioris

• Masseter

• Orbicularis oris

• Risorious

• Zygomatic major


7

Mandible

• Lower jaw

• Largest facial bone

• Important for allowing mouth to open and sounds to be amplified


8

Hard Palate

• Roof of the mouth

• Contact point for tongue to produce several sounds


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


10

Lips

• Four movements involved in speech:– Opening– Closing– Protrusion– Retraction

• Important in producing several sounds: p, b, m, w, f, v


11

Tongue

• Three biological functions: – Taste– Movement of food while chewing– Movement of food for swallowing


12

Tongue

• Primary articulator

• Important in producing several sounds:– Voiced and unvoiced ‘th’; t and d; k and g– Voiced and unvoiced ‘sh’


13

Tongue Tie

• Known as ‘ankyloglossia’

• Due to a restricted lingual frenum/frenulum

• Reduces ability of tongue tip to elevate


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


15

Intrinsic Muscles

• Superior longitudinal

• Inferior longitudinal

• Transverse

• Vertical


16

Extrinsic Muscles

• Genioglossus

• Styloglossus

• Hyoglossus

• Palatoglossus


17

Tongue Thrust

• Resting the tongue against inner surface of the front teeth or protruding tongue between the teeth


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


19

Bruxing

• Compulsive, unconscious clenching and grinding of teeth

• Can wear down the edges of the teeth


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


Chapter 10

General American

English Sound System


22

Phonetics

• Study of speech sound production

• Study of symbols used to represent speech sounds


23

Phonology

• Study of the sound system and the rules governing sound combinations


24

International Phonetic Alphabet (IPA)

• An alphabet for writing the speech sounds of all languages


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


26

Accents

• Speech pronunciation and inflections of nonnative speakers


27

Accent Modification Therapy Goals

• Reduce speech characteristics that affect intelligibility

• Add speech characteristics to make speech easier to understand


28

American English Phonemes

• Speech sound in a language distinct from other sounds in that language


29

Classification of American English Phonemes

• Place– Location in mouth of articulators

• Manner– Degree of narrowing

• Voice– Whether the vocal folds are vibrating or not


30

Place of Articulation

• Bilabial

• Labiodental

• Interdental

• Alveolar

• Palatal

• Velar

• Glottal


31

Vowels

• Described by placement of tongue during their production


Chapter 11

Etiologies of

Articulation, Phonological,

and other Communication

Disorders


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


34

Three Primary Etiologies of Communication Delays/Disorders

• Normal variation

• Environmental problems

• Physical impairments


35

Normal Variation

• Approximately 70 percent of children fall within the typical range

• Only a small number fall outside the typical range


36

Environmental Problems

• Prenatal environment

• Syndromes

• Maternal substance abuse

• Low birth weight and prematurity

• Perinatal and postnatal environment


37

Physical Impairments

• Traumatic brain injury

• Hearing impairment


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


Chapter 12

Articulation Disorders


40

Articulation Disorders

• Occur in 10 to15 percent of preschool children

• 75 to 85 percent also have language disorders


41

Articulation Disorder

• Difficulty with the articulation of speech sounds

• Implies a motor component to the disorder


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


43

Assessment Protocol

• Case history

• Assessment of speech– Screening and articulation testing

• Oral exam

• Hearing and language assessment

• Diagnosis

• Written report


44

Analysis of Data

• Number of errors

• Types of errors:– Substitutions, omission, additions,

distortions

• Consistency of errors


45

Stimulability

• Child’s ability to produce the correct sound after cueing by clinician

• Stimulability indicates a better prognosis for improvement in therapy


46

Articulation Therapy

• SLPs need to be three people in one:– Scientists– Humanists– Artists


47

Treatment Efficacy

• Studies demonstrate that speech therapy is effective in improving speech sound production and intelligibility


48

Traditional Therapy Approach

• Child is made aware of phoneme

• Child recognizes errors

• Child produces phoneme in isolation, syllables, words, phrases, sentences

• Carryover


Chapter 13

Phonological Disorders


50

Phonology

• Study of the sound system of a language and the rules governing sound combinations


51

Phonological Disorder

• Difficulty with the acquisition of a rules underlying the sound system

• 80 percent of children with phonological disorders also have language disorders


52

Theories of Phonology

• Natural phonology

• Linear/generative phonology

• Nonlinear phonology


53

Principles of Phonological Assessment

• Transcribe the whole word

• Sample phonemes in a variety of contexts

• Always sample continuous speech

• Determine stimulability


54

Therapy Approaches

• Distinctive features

• Cycles approach

• Minimal contrasting pairs


55

Distinctive Features Approach

• Teach children to produce specific distinctive features

• Teach the rules for correct use of a distinctive feature


56

Cycles Approach

• Different phonological patterns are targeted in specific time periods called “cycles”


57

Minimal Contrasting Pairs

• Create pairs of words where one word has the correct phonological pattern and the other word has the contrasting pattern


Chapter 14

Motor

Speech Disorders


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


60

Speech Characteristics of CAS

• More errors with complex sounds (fricatives, clusters)

• Errors increase with increasing length of utterance

• Omissions

• Vowel errors


61

Speech Characteristics of CAS

• Groping behavior

• Prosodic impairments

• Lack of progress with traditional articulation or phonological therapy


62

Assessment of CAS

• Case history

• Hearing screen

• Assessment of all speech systems

• Articulation testing

• Language testing


63

Therapy for CAS

• Intensive

• One-on-one

• Progress through a hierarchy of task difficulty

• Many repetitions

• Small increases in task difficulty

• Multiple modalities


64

Childhood Dysarthria

• A motor speech disorder caused by neurological damage prenatally, perinatally, or postnatally


65

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


66

Assessment of Childhood Dysarthria

• All speech systems must be evaluated individually and in coordination with other systems


67

Therapy for Childhood Dysarthria

• Primary goal of therapy is to maximize speech intelligibility


68

Cerebral Palsy

• Most common cause of dysarthria in children

• Incidence is 1 in 500 children in developed countries


69

Types of Cerebral Palsy

• Children with too much muscle tone: – Hypertonicity

• Children with too little muscle tone:– Hypotonicity


70

Classification of Cerebral Palsy

• Spastic

• Athetoid

• Ataxic

• Mixed


71

Spastic Cerebral Palsy

• Most common type– 60 to 70 percent

• Hypertonicity– Abrupt, jerky, labored movements


72

Athetoid Cerebral Palsy

• 20 to 30 percent of cases

• Slow, continuous, involuntary movements of extremities


73

Ataxic Cerebral Palsy

• 5 to10 percent of cases

• Hypotonicity

• Impaired ability to coordinate movements and maintain balance


74

Mixed Cerebral Palsy

• Combination of different types

• Spasticity and athetosis is most frequent combination


75

Cerebral Palsy: Speech/Language

• Moderate to severe unintelligibility

• Language and cognitive problems


76

Cerebral Palsy: Associated Problems

• Intellectual disabilities – 75 percent of cases

• Hearing impairments


77

Cerebral Palsy: Associated Problems

• Visual impairment – 71 percent of cases

• Seizure disorders – Occur in 45 percent of cases


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


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


Chapter 15

Emotional and Social

Effects of Articulation

and Phonological Disorders


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


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


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


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

Copyright © 2008 Delmar. All rights reserved. Unit Four Articulation and Phonological Disorders.

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Transcript of Copyright © 2008 Delmar. All rights reserved. Unit Four Articulation and Phonological Disorders.