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

Unit Four

Articulation and

Phonological Disorders

Chapter 9

Anatomy and Physiology

of the Articulatory System

Biological Function of the Mouth

• Eating

• Speech is an overlaid function

Anatomy and Physiology of the Articulatory System

• Facial bones and muscles

• Mandible

• Lips

• Hard and soft palate

• Tongue

• Dentition

Facial Bones

• Fontal bone

• Temporal bones

• Sphenoid bones

• Zygomatic bones

• Maxilla

• Mandible

Facial Muscles

• Buccinator

• Depressor labii inferioris

• Levator labii superioris

• Masseter

• Orbicularis oris

• Risorious

• Zygomatic major

Mandible

• Lower jaw

• Largest facial bone

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

Hard Palate

• Roof of the mouth

• Contact point for tongue to produce several sounds

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

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

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

Tongue

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

Tongue

• Primary articulator

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

Tongue Tie

• Known as ‘ankyloglossia’

• Due to a restricted lingual frenum/frenulum

• Reduces ability of tongue tip to elevate

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

Intrinsic Muscles

• Superior longitudinal

• Inferior longitudinal

• Transverse

• Vertical

Extrinsic Muscles

• Genioglossus

• Styloglossus

• Hyoglossus

• Palatoglossus

Tongue Thrust

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

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

Bruxing

• Compulsive, unconscious clenching and grinding of teeth

• Can wear down the edges of the teeth

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

Phonetics

• Study of speech sound production

• Study of symbols used to represent speech sounds

Phonology

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

International Phonetic Alphabet (IPA)

• An alphabet for writing the speech sounds of all languages

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

Accents

• Speech pronunciation and inflections of nonnative speakers

Accent Modification Therapy Goals

• Reduce speech characteristics that affect intelligibility

• Add speech characteristics to make speech easier to understand

American English Phonemes

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

Classification of American English Phonemes

• Place– Location in mouth of articulators

• Manner– Degree of narrowing

• Voice– Whether the vocal folds are vibrating or not

Place of Articulation

• Bilabial

• Labiodental

• Interdental

• Alveolar

• Palatal

• Velar

• Glottal

Vowels

• Described by placement of tongue during their production

Chapter 11

Etiologies of

Articulation, Phonological,

and other Communication

Disorders

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

Three Primary Etiologies of Communication Delays/Disorders

• Normal variation

• Environmental problems

• Physical impairments

Normal Variation

• Approximately 70 percent of children fall within the typical range

• Only a small number fall outside the typical range

Environmental Problems

• Prenatal environment

• Syndromes

• Maternal substance abuse

• Low birth weight and prematurity

• Perinatal and postnatal environment

Physical Impairments

• Traumatic brain injury

• Hearing impairment

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

• Occur in 10 to15 percent of preschool children

• 75 to 85 percent also have language disorders

Articulation Disorder

• Difficulty with the articulation of speech sounds

• Implies a motor component to the disorder

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

Assessment Protocol

• Case history

• Assessment of speech– Screening and articulation testing

• Oral exam

• Hearing and language assessment

• Diagnosis

• Written report

Analysis of Data

• Number of errors

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

distortions

• Consistency of errors

Stimulability

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

• Stimulability indicates a better prognosis for improvement in therapy

Articulation Therapy

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

Treatment Efficacy

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

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

Phonology

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

Phonological Disorder

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

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

Theories of Phonology

• Natural phonology

• Linear/generative phonology

• Nonlinear phonology

Principles of Phonological Assessment

• Transcribe the whole word

• Sample phonemes in a variety of contexts

• Always sample continuous speech

• Determine stimulability

Therapy Approaches

• Distinctive features

• Cycles approach

• Minimal contrasting pairs

Distinctive Features Approach

• Teach children to produce specific distinctive features

• Teach the rules for correct use of a distinctive feature

Cycles Approach

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

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

Speech Disorders

Childhood Apraxia of Speech (CAS)

• A motor speech disorder in the absence of muscle weakness

• Affects motor planning, sequencing, coordinating and initiating motor movements

Speech Characteristics of CAS

• More errors with complex sounds (fricatives, clusters)

• Errors increase with increasing length of utterance

• Omissions

• Vowel errors

Speech Characteristics of CAS

• Groping behavior

• Prosodic impairments

• Lack of progress with traditional articulation or phonological therapy

Assessment of CAS

• Case history

• Hearing screen

• Assessment of all speech systems

• Articulation testing

• Language testing

Therapy for CAS

• Intensive

• One-on-one

• Progress through a hierarchy of task difficulty

• Many repetitions

• Small increases in task difficulty

• Multiple modalities

Childhood Dysarthria

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

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

Assessment of Childhood Dysarthria

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

Therapy for Childhood Dysarthria

• Primary goal of therapy is to maximize speech intelligibility

Cerebral Palsy

• Most common cause of dysarthria in children

• Incidence is 1 in 500 children in developed countries

Types of Cerebral Palsy

• Children with too much muscle tone: – Hypertonicity

• Children with too little muscle tone:– Hypotonicity

Classification of Cerebral Palsy

• Spastic

• Athetoid

• Ataxic

• Mixed

Spastic Cerebral Palsy

• Most common type– 60 to 70 percent

• Hypertonicity– Abrupt, jerky, labored movements

Athetoid Cerebral Palsy

• 20 to 30 percent of cases

• Slow, continuous, involuntary movements of extremities

Ataxic Cerebral Palsy

• 5 to10 percent of cases

• Hypotonicity

• Impaired ability to coordinate movements and maintain balance

Mixed Cerebral Palsy

• Combination of different types

• Spasticity and athetosis is most frequent combination

Cerebral Palsy: Speech/Language

• Moderate to severe unintelligibility

• Language and cognitive problems

Cerebral Palsy: Associated Problems

• Intellectual disabilities – 75 percent of cases

• Hearing impairments

Cerebral Palsy: Associated Problems

• Visual impairment – 71 percent of cases

• Seizure disorders – Occur in 45 percent of cases

Evaluation

• An interdisciplinary team is required

• Team will include SLP, OT, PT, and other professionals specially trained to work with children with cerebral palsy

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

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

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

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

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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