Disorders of speech & Language

Dr T Balasubramanian

Introduction

Communication is a fundamental part in the developmental process

ENT surgeons are commonly involved in diagnosing and treating patients with communication disorders

Speech language therapists play a vital role in managing children with communication problems

Normal speech development essentials

Sensory stimulation normal

Imitation

Experimentation

Feedback

Sensory stimulation

Normal hearing is a must for normal speech

Hearing diability is the commonest cause of speech disturbance

Earlier hearing disability is identified and corrected chances of normal speech development is bright

Augmentation devices should be prescribed at a very early age under the age of 1 in patients with deafness

Imitation

Speech is learnt by imitation

Child loves to imitate its mother

More the mother talks to the child faster the speech develops

Experimentation

Child loves to experiment

Control and generation of speech is largely gained through experimentation

Drooling is one feature of experimentation

Drooling stops as soon as the child comes out of this phase

Feed back

Encouragement

Emotions mother

Response to sounds generated by the child

Stages of speech development

1. Smile - 6 weeks2. Laugh- 3-4 months3. Babble 4-6 months4. Copies sound 6-9 months

Stages of phonation

Phonation stage

Primitive articulation stage

Expansion phase

Canonical babbling phase

Phonation stage

Occurs during the first 2-3 months

Infant raises vowel like sounds

Sounds produced are known as cooing

Primitive articulation stage

This is also referred as gooing

Wide variety of sounds are produced by the infant in this stage

This phase is a must before the child can migrate to the expansion phase

Expansion phase

In this phase the infant combines vowels with consonents

Infant needs to be encouraged during this stage

Canonical babbling phase

In this stage the infant learns to string syllables to form complex sounds

In this phase child learns to speak works like mamma, dadda etc.

Classification of speech disorders

Receptive disorders

Expressive disorders

Mixed disorders

Receptive disorders

Neurological secondary to cognitive impairment

Sensory Secondary to hearing / visual impairment

Environmental Poor sensory stimulation

Expressive disorders

Voice disorders

Oropharyngeal structural disorders cleft palate, rhinolalia

Motor nerve and cortical disorders (dysarthria)

Fluency disorders (stuttering)

Combined disorders

Psycological morbidity (Autism)

Developmental disorders (cerebral palsy)

Speech / language delay

Commonest problem

Parental anxiety

Rescorla criteria Children at 24 months who speak less than 50 single words and use no two words combination belong to this group

Incidence is about 15% of normal population

Problems of delayed speech

Literacy problems

Socializing problems

Behavioral problems

Learning difficulties

Antisocial activities

Importance of history in diagnosis of delayed speech

Details of pregnancy

Details of delivery

Developmental milestones

Feeding history of the child

Normal speech development depends on

Respiration

Phonation

Articulation

Resonance

Velopharyngeal sphincter

Nasal speech

Rhinolalia clausa

Rhinolalia aperta

Thank you

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