Artic Final

Any difficulty with speech sounds

Speech sound disorder

Organic and functional

2 categories of speech sound disorders

Functional

Speech sound disorder with no known cause

Organic

Speech sound disorder with known cause

Articulation and phonological

Types of functional speech sound disorders

Motor/neurological, structural, sensory/perceptual

Types of organic speech sound disorders

Motor

Aspects of speech affected by articulation disorders

Linguistic

Aspects of speech affected by phonological disorders

Both lips come together

Bilabial

Lower lip touches upper front teeth

Labiodental

Tip of the tongue comes between the upper and lower teeth

Interdental

The tip or blade of the tongue touches the alveolar ridge

Lingual alveolar

Middle of the tongue touches hard palate

Palatal

Back of tongue goes up to velum

Velar

Sounds made in the glottis, the opening between vocal folds

Glottal

Popping sounds

Stop/ plosive

Train engine sounds

Affricate

Hissing sounds

Fricative

Stop/plosive

Most constricted consonants

Affricate

2nd most constricted consonants

Fricative

3rd most constricted consonants

Velum lowered, airflow passes through nose

Nasal

Air flows through narrow opening in partially closed vocal tract

Liquid

Vowel-like qualities

Glide

Glides

Least constricted consonants

Vowels, diphthongs, nasals, stops, glides, liquids, fricatives, affricates, blends/consonant clusters

General course of phonetic development

8

Age at which all sounds are acquired

18 months

Age of 25% intelligibility

2 years

Age of 50% intelligibility

3 years

Age of 75% intelligibility

4 years

Age of 100% intelligibility

Articulation, rate of speech, rhythm, stress, pauses, voice quality, pitch, resonance, fluency

Factors that influence intelligibility

Phonetics

The study of production of speech sounds and their acoustic qualities

Phonology

The study of now speech sounds function and organize in a language

Reflexive crying

Stage of phonological development 0-2 months

Cooing and laughing

Stage of phonological development 2-4 months

Vocal play

Stage of phonological development 4-6 months

Babbling

Stage of phonological development 6 months

First words

Stage of phonological development 12 months

Simple word combinations

Stage of phonological development 18 months

Cooing

Stage of phonological development when child produces vowel-like sounds with occasional consonants, nasal consonants, and nasalized vowels

Vocal play

Stage of phonological development when child produces prolonged vowel and consonant -like sounds with variations in loudness and pitch

Babbling

Stage of phonological development when child produces strings of consonant and vowel productions

Assimilation, substitution, syllable structure

Categories of phonological processes

Assimilation

Phonological process in which one sound becomes the same or similar to another sound in a word

Substitution

Phonological process in which one sound is substituted for another sound in a systematic way

Initial consonant deletion, glottal replacement, backing, idiosyncratic processes

Atypical phonological processes

Environment, personal factors, gender, sibling status, socioeconomic status, culture, psychological and emotional factors

Possible functional/idiopathic causal patterns

Otitus media with effusion

Frequent build up of fluid in middle car

Velopharyngeal insufficiency

Results in hypernasality

Enlarged adenoids or tonsils

Results in hyponasality

Dysarthria

Slow and uncoordinated speech motor movements that is caused by different types of lesions, trauma, or diseases

Apraxia of speech

Impairment in motor programming that specifically affects speech motor movement

Language disorder

Most common comorbid disorder with speech sound disorders

Stuttering, voice, ADHD, anxiety, conduct

Comorbid disorders with speech sound disorder

Case history/interview, hearing, oral motor exam, voice, fluency, language, articulation, phonology

Assessment procedures

Intelligibility, severity, phonological error patterns, stimulability, developmental appropriateness, dialect or second language

What determines eligibility?

Diadochokinesis

The ability to perform rapid sound sequences precisely

85 %

PCC considered mild severity

65 - 85 %

PCC considered mild/moderate severity

50-64 %

PCC considered moderate/severe

Less than 50%

PCC considered severe

80 %

Considered mild for intelligibility

7th - 15th percentile or 1-1.5 standard deviations below mean

Percentile and standard deviation for mild disorder

50-80%

moderate severity based on intelligibility

2nd - 6th percentile or 1.5 - 2 standard deviations below mean

Percentile and standard deviation for moderate disorder

Less than 50%

Intelligibility considered severe

Below 2nd percentile or 2 standard deviations below mean

Percentile and standard deviation for Severe disorder

Type of error and position of error

Classification of articulation errors

Substitution and omission

Most common errors in phonology

40 %

What percentage does a pattern have to occur to be considered a phonological process?

Distributed and random practice is more effective, vary the conditions during practice, aim for the standard form of a target as soon as possible instead of simplifying

Principles of motor learning

Establishment, generalization, maintenance

Stages of motor -based treatment approach

Random

Type of practice with mixed targets

Blocked

Type of practice with all similar targets

Massed practice

Fewer sessions, longer in duration

Distributed practice

Shorter sessions that are more frequent

Rate

Describes how fast or slow you go through trials

Knowledge of performance

Telling a client specifically what they are doing correctly or incorrectly

Knowledge of results

Telling the client whether the target was produced correctly or not

Sensory-perceptual training, varying and correcting productions, strengthening and stabilizing production, generalize to every day

Steps of traditional articulation therapy

Isolation, syllable, word, phrase, sentence, conversation

Steps in traditional production training

Imitation, phonetic placement, successive approximation, contextual utilization

Methods for establishment of target sound

Phonetic placement

Giving specific instruction for where to place articulators

Successive approximation

Start with a sound that is similar to the target and slowly more towards target

Contextual utilization

Identify a context in which the client can produce the sound correctly and then place into other contexts for practice

Challenge point

The level of difficulty that allows for enough feedback to facilitate learning but not decrease the efficiency and effectiveness of therapy

Tactile and visual

2 types of alternative feed back not used as commonly

Speech buddy and tongue depressor

2 examples of tactile feedback

Spectrogram, electropalatography, ultrasound

3 examples of visual feedback not used as commonly

Formal tests, word probes, judgement scales of severity and intelligibility, SOAP notes, formal progress notes

Methods used to determine progress

Phonological awareness

An individual's awareness of sounds and sound structure within a language

Rhyming, words as units, syllables, alliteration

Stages of phonological awareness

Phonemic awareness

Awareness of individual sounds in words

Phoneme isolation, blending, segmentation, addition, deletion, substitution

Stages of phonemic awareness

Individualize treatment, address organic factors, conduct ongoing assessments

General principles of intervention

Target several phonemes at a time, developmentally appropriate, stimulability, phonemes that ore visible, phonemes that may generalize, most frequent errors functional for client, unusual errors, contextual, least affected by physical differences, impacts intelligibility

Factors and approaches for selecting targets

Select targets, isolation, syllable, various word positions, phrases, sentences, spontaneous speech, generalization/carryover, maintenance

Sequence of traditional articulation treatment

Specific, measurable, attainable, relevant, time-bound

What does SMART stand for?

Approach, style, stimulus presentation, goal attack strategy, treatment intensity

Intervention considerations