Clinical Applications of Articulation Therapy

Chapter 4

Perry C. Hanavan, Au.D.

Cineradiography

• Ken Stevens x-ray film

Strain Gage

• The Iowa Oral Performance Instrument (IOPI) is used to objectively measure tongue and lip strength and endurance– Also provides biofeedback for oral motor

exercise

X-ray Microbeam• Microbeam analyzes speech

patterns by tracking small pellets placed on the subject’s tongue, teeth and nose

• Tracking accomplished by a very narrow x-ray beam passing through the subject area and detected by a sodium iodide crystal located behind the head

• Dense pellets block the x-rays from reaching the crystal

• Allows study of speech patterns in real time

Ultrasound

• Speech therapists are using ultrasound imaging 

Electropalatography

• SmartPalate

Oral Devices

• Electropalatography

• Glossometry

• Video with Dr. Samuel Fletcher

Palatometry

• Device that consists of electrodes mounted on a thin acrylic plate which is custom made to cover the individual’s hard palate and upper teeth and measures tongue and palate contact patterns from electrodes.

Glossometry

• Device that consists of electrodes mounted on a thin acrylic plate which is custom made to cover the individual’s hard palate and upper teeth and measures optical tracking of tongue surface using LED.

MRI

• Primarily suitable for static production

• Attempted to acquire dynamic MRI image sequences, i.e. MRI "movies"

• One technique involves acquisition of single images from an utterance repeated over and over

• A new technique for magnetic resonance imaging (MRI) allows movements of joints and organs to be captured in real time

Electromagnetic Articulography• See inside patients’ mouths to track

their speech movements.• Only about 40 in the world, • Holds out promise as a therapy tool for

people who have lost ability to speak.• Small sensors attached to thin wires

placed inside mouth with magnified images of mouth movements appearing on screen

• helps patients by showing how to position tongue to create speech sounds

Source Filter Theory and Problems in Speech Production• Source-filter a way of conceptualizing

problems of speech production– Dysarthria—neurologic disorder with weak speech

musculature– Hearing loss—difficulty with relationship with

acoustic input and speech production– Phonological disorders—often phoneme perceptual

problems– Tracheotomy—larynx development, tongue

movement

– Cleft Palate—velopharyngeal problems (resonance—nasality problems)

Dysarthria• Neurological disorders with weak speech

production– "Slurred" speech– Speaking softly or barely able to whisper– Slow rate of speech– Rapid speech rate with a "mumbling" quality– Limited tongue, lip, and jaw movement– Abnormal intonation (rhythm) when speaking– Hoarseness, breathiness– Drooling or poor control of saliva– Chewing and swallowing difficulty

Sample

Vowel Space

Slope index

• This parameter is measured in Hz per msec, is based on the relationship between the F2 transitions and place of articulation

“Deaf Speech”

• Individuals with congenital or pre-lingual hearing loss vs. post-lingual loss

• Loss of speech intelligibility

• Difficulty in segmental aspects of speech

• Difficulty in control of suprasegmental aspects of speech

• Difficulty co-articulating

Segmental Problems

• Most frequent errors in spoken language of deaf– Vowel problems (tend to neutralize vowels)– F1/F2/ charts shows marked limitations in both

horizontal and vertical degree of tongue movements for vowels

– Consonant errors common—omissions and substitutions involving voicing and manner of artic

– Place of production errors common because of imprecise tongue position and reduced articulatory movement

Acoustic Analysis of Speech

• Alveolar and velar stops produced further back in the vocal tract than normal– Provides clues for speech therapy

Suprasegmental Aspects

• Incorrect Fo in word and sentence production

• Not enough variation in Fo to differentiate between declarative vs. interrogative utterances

Sample

Speech Therapy Emphasis

• Some programs put emphasis on speech in education process, others some, and yet others put none

• Maasen & Povel (1985) research showed improving segmental production caused 50% improvement in intelligibility with major increase resulting from correcting vowel production

Phonological Disorders

• Speech disorder known as an articulation disorder.

• Do not use some or all of the speech sounds expected for their age group.

• Phonological processes– Children use alternative articulation or simpler

articulatory gestures in place of the adult model

– May produce a /t/ for /k/ sound– Sample

Tracheostomy

• Surgical procedure to create an opening through the neck into the trachea 

• Developmental consequences in infants including:– Prevention of larynx from making developmental

descent– Thus limiting movement of tongue– Reduction in articulatory movements– Alteration of resonance characteristics– Sample– Sample

Cleft Palate

• Congenital split in the roof of the mouth.

• Resonance issues

• High incidence of conductive hearing loss (typically middle ear infections)

Sample

Sample

Sample