Unit 3

Question 1

What are speech sound disorders?

Answer 1

Include difficulties with producing certain sounds (articulation), with the patterns of language (phonological), and/or with oral-motor planning (apraxia).

Question 2

What is phonology

Answer 2

Study of how sounds are organized

Study of sound system of a given language

Phonology is related to all other aspects of language (phonetics, pragmatics, morphology, syntax, and semantics)

Question 3

Phonological development

Answer 3

The way sounds are stored in our brains

The way sounds are produced

The rules/processes that bridge the way the sounds are stored and the way they are produced

Question 4

Intelligibility

Answer 4

By 18 months a child’s speech is normally 25% intelligible

By 24 months a child’s speech is normally 50 -75% intelligible

By 36 months a child’s speech is normally 75-100% intelligible

Question 5

Phonological disorder (phonemic disorder)

Answer 5

A language disorder that affects a speaker’s production and/or mental representation of speech sounds of target language

Same errors over and over is a big indicator for if it’s a phonological disorder versus apraxia

Question 6

Articulation disorders

Answer 6

A speech disorder that affects the individual’s ability to produce certain sounds (phonetic disorder)

Cause may be underlying muscle weakness/dysarthria

Cause may also be unknown=functional articulation disorder

Ex: otitis media when infant, maybe didn’t learn certain sounds and cant produce them

Someone can have multiple articulation disorders and still have an artic disorder, not phonological disorder but may be as unintelligible

Question 7

Apraxia of speech

Answer 7

Motor planning disorder
Characterized by:
- difficulty imitating speech sounds
- difficulty imitating non-speech movements (oral apraxia), such as sticking out their tongue
- groping (see people trying to find the sound) when trying to produce sounds
- in severe cases, an inability to produce sound at all
- inconsistent errors
- slow rate of speech
- somewhat preserved ability to produce “automatic speech” (rote speech), such as greetings like “How are you?”

Speech sound disorder about motor planning
No underlying muscle weakness, or nerve damage, or paralysis

Question 8

Apraxia - Sensorimotor Speech Disorder

Answer 8

Differential Diagnosis:

articulatory struggle

errors increase with length of stimuli words

errors inconsistent

Question 9

Dysarthria

Answer 9

• A motor speech disorder
• Associated with paralysis, paresis or in-coordination, slowness or sensory loss of speech musculature
• Generic label for group of disorders
• Effects muscle groups involved in respiration, phonation, articulation and resonation
• Damage may be peripheral or central nervous system

Question 10

Dimensions of Dysarthria (1)

Answer 10

Phonation
Pitch
	1. Pitch level
	2. Pitch breaks
	3. Monopitch
	4. Voice tremor

Intensity

1. Monoloudness
2. Excess loudness variation
3. Loudness decay
4. Alternating loudness
5. Loudness (overall) 

Quality

1. Harsh voice
2. Hoarse (wet) voice
3. Breathy voice (continuous)
4. Breathy voice (transient)
5. Strained/strangled voice
6. Voice stoppages

Question 11

Dimensions of Dysarthria (2)

Answer 11

Resonation

1. Hypernasality
2. Hyponasality
3. Nasal emission

Respiration

1. Forced inspiration/expiration
2. Audible inspiration
3. Grunt at end of expiration

Articulation

1. Imprecise consonants
2. Phonemes prolonged
3. Irregular articulatory breakdown
4. Phonemes repeated Vowels distorted
5. Intelligibility

Question 12

Dimensions of Dysarthria (3)

Answer 12

Prosody

1. Rate
2. Phrases short
3. Increase of rate in rate overall
4. Reduced stress
5. Variable rate
6. Intervals prolonged
7. Inappropriate silences
8. Short rushes of speech
9. Excess and equal stress

Question 13

Intensity can be increased by

Answer 13

• increasing number of sessions
• eliciting greater number of responses
  
  • can be accomplished by using clickers/counters
• engaging students by keeping a fast pace and a stronger routine.

Question 14

Speech Sound Disorders: Treatment Considerations

Answer 14

Need to consider service delivery models:
Need to create the most efficient model based on individual clients and SLP roles/responsibilities
Group and individual services
Push-in services
Pull-out/”push away” services
Number of sessions per week/day
Itinerant services

Question 15

The cycles approach

Answer 15

This approach derived from developmental phonology

Each cycle is based on number of error patterns and stimulability

Typically, each error pattern is targeted from two-five hours per cycle

Phoneme or cluster is targeted for one hour per week (one 60 minute session or two 30 minute sessions)

Question 16

Cycles approach continued

Answer 16

Foci are processes, rules or classes of sounds

Goal to increase intelligibility

Work within context of
phonemic contrasts, generally within whole word contexts

Overexposure to structures
Establish auditory-perceptual base

Question 17

Cycle approach examples

Answer 17

Cycle: the time period required for a client to successfully focus for 2-3 hours on each of her/his basic deficient patterns

A different phoneme (or cluster) within a pattern is targeted for about 60 min. each

Example:
Cycle 1:
Final consonant deletion, using /p, t, s, f/

Cycle 2
Velar fronting - k, g (initial word position)

Cycle 3:
Weak syllable deletion

Cycle 4
S clusters - st, sp, sk, ks, ts

Approach can be used in a variety of settings (schools, private practice, hospitals)

- Child reviews picture cards from past session.
- SLP reads list of 20 new targets (approximatley 30 seconds) using slight amplification
- Production/practice activities with target error pattern (eight to 10 minutes)
- Phonological awareness activity

• SLP probes for target for next session (i.e. cluster that child produces the best)
  
  • SLP reads list from beginning of session with slight amplification
  • Home program provided including listening list and picture cards for practice (recommended that this is practiced for two minutes everyday)

Question 18

Complexity theory

Answer 18

• start with the most difficult sounds and sound clusters, such as “scr” and “shr,” so the effects of therapy will trickle down to improve upon less complex sounds
• Teach sounds produced with with 0% accuracy that are nonstimulable and later acquired

Question 19

Complexity theory in practice

Answer 19

Teach sounds in 3 to 5 high frequency words

Teach sounds that induce the greatest predictable generalization

Teach minimal pair contrasts that involve two new sounds with maximal and major class differences
        Maximal oppositions
        Obstruents (stops, fricatives,  affricates) vs. sonorants (vowels, glides, nasals)

Question 20

Prompt Therapy

Answer 20

-Used with both children and adults with variety of speech sound disorders such as:
Apraxia, dysarthria, phonological impairments, and individuals with hearing impairments

• System of treatment that aims to integrate motor, cognitive-linguistic, and pragmatic components of language
• Based on pressure, touch, kinesthetic, and proprioceptive cues.

Question 21

Prompt Therapy

Answer 21

SLP cues articulatory movement with hands

Helps individuals to “get a feel” for the movements

May begin with gesture movements
Use meaningful words when possible
Syllable sequence drills
Such as guduba – go to bed

Question 22

Speech Sound disorders: treatment considerations

Answer 22

Need to work on the right skill with the most intensity in order to obtain the best results.

“If the intervention is effective but not efficient, we reach the right goal-just much later. If it is efficient but not effective, we will reach the wrong goal.“

Question 23

Articulation & Phonological disorders

Answer 23

Functional (no known cause of issue) speech disorders can persist into adulthood.
- These disorders are often a source of stress for adults.

Adults with functional speech disorders often have difficulty (distortions and /or substitutions) of one or two sounds, like /s/ and/z/, or just /r/, or just /l/.

Motivation plays a role in the prognosis for adults. When motivated, adults who receive therapy and practice can remediate these errors.

Question 24

Articulation & Phonological disorders treatment

Answer 24

Traditional therapy (moving through a hierarchy)

Other approaches (biofeedback, etc.)

Need to consider the affect of disorder on functional communication and on client’s life circumstances (family, job, etc.)

In what setting(s) might SLPs work with adults with functional articulation disorders?: outpatient clinics, private practices, colleges

Hierarchy: moving throw easiest to hardest: syllable level to word level to phrase level to sentence level

Complexity theory: start hardest thing hoping it will fix everything else

Question 25

Apraxia

Answer 25

Treatment includes drill and practice and re-training motor patterns for correct production in syllables, sounds, and in sequencing these into words. May work on pace and rate of speech -Oral and verbal apraxia often exisit Therapy targets should be individualized to include: - Articulating vowel and consonant sounds - Speaking words varying in syllable length - Verbalizing common phrases - Articulating sentences ranging from easy to complex - Fluently engaging in spontaneous conversations - Using intonation and verbal inflection appropriately

Question 26

Apraxia Oral motor exercises

Answer 26

``` Oral Motor Exercises: Blowing bubbles Blowing a harmonica Using a straw Tongue Press Jaw isometrics Brushing Icing Licking ice cream Peanut butter on the lips ``` Absolutely important that FEEDBACK is included in the exercises

Question 27

What is the difference between apraxia and dysarthria?

Answer 27

Apraxia: motor planning, muscles are fine Dysarthria: damage, muscle incoordination, paralysis KNOW MORE

Question 28

Dysarthria

Answer 28

Treatment depends on type of dysarthria (ataxic, spastic, hyperkinetic, hypokinetic, and mixed) Exercises and compensatory strategies AAC for individuals with severe dysarthria Muscle exercises may include relaxation techniques (when there is increased muscle tone) Muscle exercises may include strengthening techniques with loss of muscle tone (flaccid) Breathing exercises are important to help sustain adequate breath support for speech

Question 29

Dysarthria strategies

Answer 29

Compensatory strategies may include decreasing the rate of speech, using a metronome or tapping system Decreasing length of utterance to include key words/phrases Overemphasizing consonants and articulatory movements Taking breath breaks after every few words Using visuals such as gestures, communication page with core subjects, alphabet chart Voice therapy for individuals with dysarthria: Yawn-sigh (hyperfunction/tense) Laryngeal adduction exercies (to promote vocal fold closure) such as pushing/pulling, holding breath, glottal attack

Question 30

Dysarthria examples

Answer 30

Laryngeal Adduction Examples: 1. Hold your breath as tightly as possible while pushing down or pulling up on your chair with both hands for 5 sec. 2. Be seated. Bear down against a chair with only one hand. Produce clear voice simultaneously 3. Repeat ‘ah’ 5 times with a hard glottal attack on each vowel. - Two sets of exercises - Completed five to ten time per day for five minutes - Each exercise 5 times before moving on to the next exercise in the set - Series of exercises should be repeated three times