SLP 456: final sg

what is phonological awareness?

an individual's ability to attend to the sound structure of a language, separate from meaning

-the conscious ability to detect and (mentally) manipulate sound segments (in an auditory/oral modality)

-includes 3 main categories of skills:

1) segmenting: separating segments into smaller units

2) blending: combining segments

3) manipulating: adding, deleting, or substituting segments

what is phonemic awareness?

the understanding that words are composed of individual sounds that can be separated and manipulated

-ex: if you tell someone that your name is "mark" with a "c", they may spell it either "cark" or "marc"

why are phonological/phonemic awareness important for SSD treatment and diagnosis?

the foundation of literacy is phonological

-phonological awareness and letter sound correspondence are critical to become a skilled reader

-without these skills, children can only guess what a word is from context, which is NOT the same thing as reading

-learning to read has a direct effect on the development of phonemic awareness (esp. sound-letter correspondence)

rationale for phonological awareness:

-PA skills in Kindergarten and 1st grade are strong predictors of future literacy success

-direct training in PA skills and letter-sound correspondence can improve reading/spelling outcomes

-children with phonological (phonemic-based) disorders are at higher risk for literary problems

-PA skills are easy to integrate with therapeutic interventions for SSDs

-PA skills are a CCSS (school based SLPs support common core)

-PA skills are tuaght explicitly during early literacy instruction in school

what is the phonological awareness continuum (simple to complex PA tasks)

SIMPLE TO COMPLEX:

1) listening

2) rhyme and aliteration

3) phrases and sentence segmentation

4) syllable blending and segmentation

5) onset-rime blending and segmentation

6) phoneme blending, segmentation, and manipulation (the development of phonemic awareness)

what 5 components MUST be included in an SSD assessment and why?

a comprehensive eval is a series of tests, activities, and/or observations that involves a more detailed and complete collection of data (than screenings) and includes:

1) hearing screening -can the child hear?

2) speech mechanism eval (OME) - ensure there are no structural/organic cause of SSD

3) standardized speech assessment (with stimulability measures) - 2 below 7th percentile to qualify

4) conversational speech sample (in multiple contexts) - bc assessment is not conventional/natural

5) evaluation/screening of other speech/language domains - receptive/expressive screening/evaluation

Why are OME/SMEs and hearing screenings so important for SSD assessment?

-both the OME and hearing screenings are used to determine if the child has an organic SSD

-if the child has anything wrong with them anatomically that could be affecting their speech/lang abilities (hearing loss/tongue tie/cleft), we want to identify it immediately

hearing screening

it is UNETHICAL to complete a child's speech-language assessment if hearing is not screened as undetected hearing loss may result in:

1) impeded speech-language acquisition

2) academic/learning difficulties

3) restricted social emotional development

-important to consider medical history relevant to hearing (recurrent OM, ear tubes, hearing aids)

hearing screening procedures

1) visual inspection of outer portion of ear (otoscopy)

2) pure tone hearing screening (pass/fail for each ear)

3) OAE

4) tympanometry

speech mechanism evaluation (SME/OME)

SME is a screening that looks at all structures and functions of the speech mech to determine if:

1) speech mech is within functional limits (WNL)

2) a medical referral is necessary

3) an organic SSD should be considered

what we are looking for: functional integrity

pros and cons of standardized assessments

pros:

1) less clinical time and cost efficient

2) scores from these tests allow the clinician to compare an individual client's performance with the performance of others of a similar age and is often required to determine eligibility

3) results provide clinician with a quantifiable list of "incorrect" sound productions in different word positions

cons:

1) often only tests isolated words (not naturalistic)

2) focused on articulation rather than prosody

3) test may not reflect words most relevant for child at home/school

4) limited valid with CLD clients

supplemental procedures to standardized assessments

1) transcribe a spontaneous speech sample

2) evaluate/observe error sounds in multiple phonemic contexts (word positions, neighboring sounds, level of production)

3) error analysis (types of errors and phonological patterns)

4) stimulability testing

stimulability

evaluating a clients ability to improve the production of a misarticulated sound after a clinician mode/cue

-this helps determine:

1) effective types of cues (auditory/visual model by showing anatomically, verbal/tactile cues such as tongue depressors)

2) level or production to target first (sound, syllable, word, phrase)

3) traditionally, stimulable sounds may be initial therapy targets

4) targeting nonstimulable sounds may facilitate faster progress according to the complexity approach

-ex: take sound child is getting wrong, ask the child to say it once, and see if they correct it in following attempts once you have modeled, cued, and prompted

additional measures/other ares SLPs need to assess

1) language screening

-per ASHA, 11%-40% of children with SSDs have concomitant language disorders

2) prosody

-variations in loudness, pitch (intonation), duration (rate), and stress; also rhythm (how stressed and unstressed syllables are distributed)

3) phonological and phonemic awareness

-early speech and emerging literacy interact dynamically

4) communicative participation

-important to consider the impact the SSD on daily social functioning

emerging phonological systems

refers to the span of the time during which conventional words first start to appear

-alternative approaches:

1) analyze the child's speech system (phonemic inventory, syllable shapes, phonotactic constraints)

2) caregivers are the SLP best resource (as caregivers to record speech at home; bring familiar objects to assessment; observe child-caregiver interactions)

3) play based (OME can be a game looking for "animals"; clinicians and child can take turns with flashlight)

4) babbling analysis (more frequent use of consonants and more varied syllable shapes are associated with typical phonological development)

children with unintelligible speech

alternative approaches:

1) make context known such as supply topic and using scripted/routine events

2) caregivers can act as interpreters

3) glossing - repeat a child's approximation with normal pronunciation during recording so it will be easier to identify later (when context is lost)

inventory of speech sounds

all the speech sounds that the client articulates

distribution of speech sounds

the position in a word/syllable where a speech sound is articulated correctly or incorrectly (esp. with respect to consonants)

-prevocalic position: onset of the syllable

-postvocalic position: coda of the syllable

-intervocalic position: between two vowels

what are the 3 measures important for SSD clinical decision making?

1) inventory

2) distribution

3) stimulability

what are the 5 error types/patterns that SLPs are looking out for?

1) omissions/deletions: one or more speech sounds in a word are not produced; ex: "ball" [ba]

2) substitutions: one sound is replaced with a different sound; ex: "kite" [tait]

3) additions/insertions: an additional speech sound is inserted into a word; ex: "black" [buh lak]

4) distortions: a speech sound's phonetic features are altered or changed; ex: dentalized /s/ or lateral /s/

5) syllable-level errors: (weak) syllables are omitted; a word's syllable shape is simplified/modified

what types of speech errors are present/predominant?

1) substitutions

2) omissions

3) distortions

4) additions

5) syllable structure processes

do syllable structure processes predominate?

final and initial consonant deletions often lead to unintelligible speech

are the errors consistent or inconsistent

consistent=better for diagnosis and intelligibility

inconsistant=possible CAS

impaired phonemic function

loss of phonemic contrast is the central problem of clients with phonological impairments

-children with impaired phonemic function are unable to phonemically contrast phonemes from one another

-2 examples of this are:

1) phonemic contrast neutralization/collapse

2) homonymy

phonemic contrast neutralization/collapse

two or phonemes are represented by the same speech sound production; the meaning-differentiating function of the phoneme has been lost (neutralized/collapsed)

-usually takes place because lots of sounds are not in the child's phonemic inventory so they use phonemes they can say

-big effect on intelligibility

-results in homonymy

-ex: the meaning-differentiating function of the phoneme has been lost (neutralized/collapsed)

-ex: [dai] is said for "time" "five" "slide" meaning that the phoneme contrast collapse is the [d] phoneme

homonymy

two or more words with different meanings that have identical (or similar) pronunciations

-homonyms: words that have the same pronunciation (and/or spelling) but different meanings

-ex: [dai] for a child may mean "time" "five" and "slide"

differential diagnosis system

-goes from a mild to severe scale of intelligibility based on the type of disorder the child has:

1) articulation disorder: inability to produce certain phones, typically s- and r- sounds

2) phonological delay: error patterns are developmental but delayed

3) consistent phonological disorder: non-developmental idiosyncratic patterns

4) inconsistent phonological disorder: variable production of the same item

5) childhood apraxia of speech: multi deficit motor-speech disorder

articulation disorder

atypical motor productions of speech sounds that may interfere with intelligibility and are age-inappropriate

-speech FORM errors

characteristics include:

-inability to pronounce certain phonemes (typically /s/ and /r/)

-consistent distortions or substitutions for target sound in both spontaneous and imitated productions

-typically in the mild-to-moderate range of severity

-usually identified during school-aged years

-least likely group for comorbidities (ranged from 17.5% comprehension to 51.6% phonological awareness problems)

phonological delay

error patterns are developmental (phonological patterns) but are delayed

characteristics of children with phonological delay:

1) phonological patterns observed in a typically developing child at a younger chronological age (most or all patterns considered typical)

2) typically in the mild-to-moderate range of severity

3) usually identified between ages 3-6 (before school aged)

4) comorbility: 50% vocab difficulty, 75% phonological awareness problems

consistent phonological disorder

non-developmental idiosyncratic patterns

characteristics of consistent phonological disorder:

1) consistent use of some non-developmental error patterns (idiosyncratic phonological processes) and is usually mixed with delayed developmental patterns

2) typically in the moderate-to-severe range (may be highly unintelligible)

3) usually identified between ages 3-6 (before school aged)

4) comorbidiites: 60% vocab, 46% expressive language, 82% phonological awareness problems

inconsistent phonological disorder

variable production on the same item

characteristics of inconsistent phonological disorder:

1) variable/inconsistent productions of the same word; articulations vary when a child utters the same word on different occasions (minimum 40% variability)

2) typically in the severe-to-profound range (and most pervasive)

3) child often referred due to unintelligibility

4) highest rate of comorbidities (language and phonological awareness)

5) may not respond to conventional phonological therapy (stabilization of productions may be required first)

what is speech intelligibility?

a perceptual judgement of how understandable of an individual's speech is (a SUBJECTIVE measure)

-often determined by how much a speaker's utterance is recognizable to a listener

-many factors influence intelligibility:

1) known vs. unknown contexts

-whether or not the meaning of an utterance can be inferred from the context alone

-ex: toy or food is nearby (meaning is known in advance)

how is speech intelligibility measured?

ways to measure intelligibility:

1) rating scales (1=intelligible, 10=totally unintelligible) (qualitative)

-important to get rating from multiple communication partners

2) % of words or syllables understood (quantitative)

-number of words/syllables understood divided by total number of words/syllables

-different levels include single words/sentences/conversation

what are the 4 factors that influence speech intelligibility?

1) articulatory/phonological factors:

-number, type, frequency of speech sound errors

-how "typical" or idiosyncratic speech sound errs are

2) linguistic factors:

-vocab/semantic and morphosyntax skills of child

-length and complexity of utterances (single word, sentence, conversation)

3) contextual factors:

-meaning of utterance is known/unknown to listener

-familiarity of listener with the child or their speech patterns

4) environmental factors:

-amount of background noise, location, and type of speaking situation

developmental intelligibility norms

-2 YO=50% intelligible

-3 YO=75% intelligible

-4 YO=100% intelligible

severity

-(ASHA) a qualitative judgement made by the clinician

-it indicates the impact of the SSD on functional communication

-typically defined along a continuum from mild-severe-profound

-ways to measure:

1) percentage of consonants correct (PCC)

-phonetically transcribe a speech sample or PCC forcumla (correct consonsts/total consonants) x 100

2) protportion of whole word correctness

-correct words/total words x 100; easier and faster but not as accurate

3) standardized tests can measure severity based on the standard distribution

SSD severity must take into account what 4 factors?

1) health condition

2) activities and participation

3) environmental and personal factors

4) body structures and functions

dialect

a variation of speech and/or language based on:

1) geographical area

2) native language background

3) social/ethnic/racial group membership

-each and every dialect is equally valid and rule governed language system

-all serve a communicative and social solidarity function

-each dialect is a symbolic representation of a speakers background and identity

accent

the unique way that speech is pronounced by a group of people speaking the same language:

-can be regional

-or caused by L1 speech influences

idiolect

idiosyncratic speech patterns/characteristics that are unique to a particular individual

-everyone has their own way of speaking that is not the same as another person

cultural and linguistic competence

skills, knowledge, and attitudes needed for practitioners to effectively interact with individuals from diverse cultural and linguistic backgrounds

language vs. dialect differences

languages:

1) less mutually intelligible

2) more standardized ("official" form set by government or guidebooks)

3) writing system usually based on "standard" dialect of a language

4) often associated with a natural identity (political group)

5) viewed as having distinct history, not shared with other languages

dialects:

1) more mutually intelligible

2) less standardized (less formal; evolves "organically")

3) may exist predominantly as an oral language

4) associated with a subgroup of speakers (region, race, ethnicity)

5) often viewed as variations of a shared "parent" language

what are some features of language?

1) less mutually intelligible

2) more standardized ("official" form set by government or guidebooks)

3) writing system usually based on "standard" dialect of a language

4) often associated with a natural identity (political group)

5) viewed as having distinct history, not shared with other languages

what are some features of dialects?

1) more mutually intelligible

2) less standardized (less formal; evolves "organically")

3) may exist predominantly as an oral language

4) associated with a subgroup of speakers (region, race, ethnicity)

5) often viewed as variations of a shared "parent" language

formal standard english

a dialect of english, based on the written language, primarily used in formal speaking situations (academic conferences, newscasts, job interviews, professional presentations)

-this is the idealized form of english (grammar books, usage guides)

informal standard english

most spoken English (ex: GAE) that is not considered a vernacular dialect

-exists on a continuum of "standardness" based on listener perceptions and judgements (standard to vernacular)

-"standard" is always a moving target

vernacular dialects

varieties of English that are typically considered "nonstandard" or "informal"

-commonly signaled by differences in grammatical structures as well as pronunciation (not simply an "accent")

-often associated with a particular group of speakers (region, social class, ethnicity/race)

-may be stigmatized (viewed as "nonstandard" and associated with lower social status and/or educational level

-can serve as a signal for one's cultural identity

-ex: "I was fixin to get me a buggy at the Piggly Wiggly"

what are the 2 main types of dialectical variations

1) regional dialects (the west, the north, the sound, the midland)

2) social/ethnic dialects: based on socioeconomic status or race/ethnicity, such as AAE

-varies along ALL linguistic parameters

regional dialects

dialects that emerge in different parts of the world based on region

typically classified by:

1) differences in vocabulary

2) phonological patterns (unique to pronunciation patterns)

three important phonetic variables:

1) vowel chain shifts

2) vowel mergers

3) variations in rhoticity (r-colored vowels may loose r coloring)

vowel (chain) shift

systematic changes in the articulatory features of a vowel; neighboring vowels also shift to maintain phonemic distinctions

-one vowel changes its position and all vowels will follow in a chain reaction

vowel merger

two different vowels are articulated identically (or similarly); the phonemic distinction between the vowels is lost

-ex: cot vs. caught merger in the US vs. Britian

derhotacization

/r/ is derhotacized in postvocalic position (ex: r colored vowels and rhotic diphthongs lost their r-coloring)

-ex: FDR "power" turns into "powuh"

language transfer

the incorporation of features from one's native langue (L1) into the second language (L2) being learned

nonnative accent

the phonology of a speaker's native language influences the pronunciation of the new language being learned (ex: substitutions, omissions, distortions)

english language learner (ELL)

an individual who is learning English as a second language: currently the preferred terminaloy, per U.S. dept. of Ed.

-special treatment in schools (use of , no language disorder in both languages, don't provide intervention

silent period

many El children go through a period where they focus more on understanding a new language: they any appear very quiet and shy (may last weeks, months, or up to around a year)

-teacher may say child is selectively mute

style shifting

changing the way you speak in different settings/situations, often based on:

1) group dynamics

2) communication expectations (culturally defined)

3) authority or prestige of the listener (ex: peer vs. boss)

-often involves shifting registers (formal to informal)

code switching

switching back and forth between dialects or languages based on a given speaking situation

-ex: lady goes from gallah dialect to "standard" english

articulation therapy

-focused on motor production (FORM) of speech sound

-single speech sounds targeted to achieve articulatory accuracy (ex: explicit training in manner, place)

-hierarchical: single to complex (sound in isolation to CV to word to phrase/sentence to conversation)

phonological therapy

-focused on linguistic FUNCTION of speech sounds

-groups of speech sounds targeted to establish phonemic contrasts (ex: sound classes, error patterns)

-naturalistic communicative context emphasized (ex: word level or conversation games/activities, may target more complex sounds first to induce system-wide changes)

articulation vs. phonological therapy

articulation therapy:

-focused on motor production (FORM) of speech sound

-single speech sounds targeted to achieve articulatory accuracy (ex: explicit training in manner, place)

-hierarchical: single to complex (sound in isolation to CV to word to phrase/sentence to conversation)

phonological therapy:

-focused on linguistic FUNCTION of speech sounds

-groups of speech sounds targeted to establish phonemic contrasts (ex: sound classes, error patterns)

-naturalistic communicative context emphasized (ex: word level or conversation games/activities, may target more complex sounds first to induce system-wide changes)

traditional motor approach

-treatment focused on the motor production of speech sounds (speech sound FORM; place, manner, voice)

-hierarchical: each errored sound treated individually and sequentially (simple to complex or early to later developing treatment production)

-utilizes explicit production training to achieve articulatory accuracy (ex: phonetic placement or sound shaping)

-adopts principles from the science of motor learning

(methods effective for learning any motor skills; ex: feedback and practice)

-approach integrates well with most other speech sound therapy methodologies (does not need to be standalone)

phonological approaches overview

-therapy focused on linguistic FUNCTION of sounds

-groups of sounds are targeted:

1) sound classes (ex: fricatives, velars) and error patterns (ex: stopping)

2) targets are identified by analyzing the child's phonological system

-phonemic contrasts established (often with minimal pairs) and this targets phonemic contrast collapses/neutralizations

-naturalistic communicative context is emphasized (ex: use of speech that carriers meaning)

guidelines for target selection

1) intelligibility impact (ex: high-frequency sounds, omission errors, idiosyncratic errors, homonymy)

2) developmental norms (start with earlier/later developing sounds)

3) stimulability (sounds most responsive to cues/modeling/feedback)

4) linguistic function (ex: word-final /s,z/ important for plurals, possessives, 3rd person singular, copula/auxiliary contractions)

5) generalization potential (carryover to untreated sounds; ex: stopping may affect around 8 phonemes)

6) "easy to teach" sounds (visible sounds like /b,p,t,d,s,z,l,f,v/)

7) personal/motivational factors (ex: sounds in child's name)

motor approach treatment progression

1) sensory-perceptual training

2) production of sound is isolation

3) production of sound in context

4) carryover/dismissal

stage 1: sensory-perceptual training

methods to help a child acquire a stable perceptual representation of the target phoneme (before treatment)

-ear training/identification: listening/auditory tasks to ensure that child can differentiate between the target sound and other sounds

-auditory bombardment: child exposed to variations of target sound (loud/soft, long/short, varied word positions/prosody, different speakers)

-auditory discrimination: child presented with errored and correct productions of target sound; child identifies errors (and/or explains them)

-isolation: child presented with target sounds in words; child identifies which position the sound occurred

stage 2: production of sound is isolation

goal: establish a correct/standard production of the errored speech sound on its own (AKA sound establishment phase)

-imitation: clinician models the target sound and asks client to imitate it

-phonetic placement: visual/tactile cues and verbal instructions to guide client's articulator s towards a correct production; complex articulations can be broken down in to smaller phonetic components

-sound modification: starting with a sound the client accurately produces that is similar to the target sound and shaping it towards the target sound (ex: slide tongue back while making an /s/ sound to arrive at /sh/)

stage 3: production of sounds in context

goal: stabilize the client's accurate production in contexts of increasing length and complexity (AKA sound stabilization phase)

-facilitating contexts: coarticulatory conditions that can evoke an accurate production (ex: velar /ng/ in finger used to elicit velar /g/)

-nonsense syllables: maintain accuracy in various vowel contexts (ex: [gi, gu, guh])

-words: one syllabele CV words to multisyllabic words to consonant clusters

-phrases/sentences: carrier phrases (ex: "I see a") to sentences

-conversation: ultimate end goal carryover/generalization to spontaneous speech outside the therapy room

stage 4: carryover and maintenance

dismissal from therapy occurs after client attains:

1) carryover: generalization of the learned articulation skills to non-therapeutic settings (spontaneous speech in clients daily life)

-homework assignments

-observations of client in multiple communicative contexts

-rating scales (self eval, caregivers, teachers, etc)

2) maintenance: client maintains learned skills over time and in all communicative contexts:

-as needed, therapy can shift to a consultative service delivery model (ex: client attends speech once a month for a brief "check in"

what are the principles of motor learning?

motor learning: the acquisition and refinement of motor skills through practice (structured repetition) and experience (functional use of the skill over time)

-speech is a complex motor skill, and motor learning leads to:

1) increased smoothness, speed, accuracy, and coordination of articulator movements

2) long-lasting changes to the structure and function of the nervous system

-requires both: practice and feedback

factors affecting practice for motor learning

intentional repetition of a motor skill to improve performance

1) amount: larger amount indicated for more severe SSDs

2) distribution: massed=less time between practice sessions; distributed=more time between sessions

3) variability: constant=repeating skill without variations in the same contexts; variable=repeating skill with variations in varying contexts

4) accuracy: errorless=practice designed so client does not make errors; effortful: client makes and corrects errors to refine target skill

5) attentional focus: internal=client focuses on their articulators; external=client focuses on end product of speech productions (ex: words)

6) simple to complex and part to whole

factors affecting feedback for motor learning

information provided to the client about their performance

-feedback type

1) knowledge of results informs clients if production was correct/incorrect

2) knowledge of performance informs clients WHY their productios were incorrect (ex: try it again but keep your tongue behind your top teeth)

3) audiovisual feedback (ex: recording of clients speech performance)

4) biofeedback (ex: palpation, mirror, spectrograph, ultrasound, apps)

-feedback frequency: high (>50% of responses) vs. low (<50% of responses); frequency reduces as treatment progresses to support self-monitoring

-feedback timing: immediate vs. delayed (feedback after a delay a few seconds supports self-monitoring skills)

minimal opposition

-pairs of words that differ by only one phoneme (minimal pairs); sounds pair traditionally include one phone child produces correctly and one phone the child misarticulates

-ex: [s] and [t] (see-tea) with the /t/ being in the child phonemic inventory and the /s/ not in the child's inventory

maximal opposition

-sounds that differ maximally in their distinctive (phonetic features); both phones may or may not be in the child's phonemic inventory

-ex: [r] and [k] (ray-kay) with the sounds in the pair sharing NO common phonetic features (voice, place, manner) and both sounds not mastered by the child or in their phonemic inventory

multiple oppositions

-pairs of sounds that contrast the child's error sound with 3-4 carefully selected and maximally distinct sounds; approach is tailor made for phonemic contrast collapses

-sound pairs selected from a child's phonemic contrast collapse (ex: child substitutes /d/ for multiple phonemes) and its appropriate for the paired sound to be complex (affricates, clusters)

-ex: child using /d/ for multiple phonemes does [d-k] (deep-keep) then [d-tS] (dew to chew)

childhood apraxia of speech

a pediatric neurological SSD characterized by difficulty planning and/or programming the sequence of motor movements required for accurate and consistent speech and prosody in the absence of neuromuscular deficits (ex: no abnormal reflexes, paresis, or paralysis)

-problem in the connection of "brain to mouth" as child may know what to say but their brain struggles to coordinate their speech movements

-etiology/causes:

1) known neurological event (intrauterine stroke, TBI, infection

2) neurobehavioral disorders (autism, genetic syndrome)

3) idiopathic (most ppl its this)

-diagnosis:

1) SLP provides diagnosis and differentiates between CAS, functional SSD, and motor speech disorder and may refer to other professionals for non-speech issues

what are the 3 distinctive SPEECH features of CAS?

1) inconsistent errors on consonants/vowels in repeated productions

2) lengthened and disrupted sound/syllable transitions (impaired coarticulation; syllables don't move smoothly from one to another)

3) impaired prosody especially lexical and phrasal stress (monotone stress)

what are 3 NONSPEECH motor features of CAS?

1) groping behaviors: searching for articulatory position prior to production

2) silent posturing: positioning articulators without sound production

3) impaired nonspeech oral volitional movements (smiling or blowing a kiss)

cleft palate

incomplete fusion of the palate during prenatal development, often leading to velophrayngeal dysfunction and a fistula (opening) between the nasal and oral cavities

-results in problems with feeding, swallowing, speech, and facial appearance (hearing may also be impacted due to chronic infection)

-requires surgical intervention and long-term multidisciplinary medical management

submucous cleft palate (SMCP)

oral mucosa is intact, but the underlying velar musculature failure to attach at midline during prenatal developement

-cleft is not easily visible and difficult to detect

-may still impact speech via velopharyngeal dysfunction

-3 SIGNS:

1) blue discoloration (shine light in mouth to see underneath tissue)

2) palpable bony notch at edge of hard palate

3) bifid uvula (issues with velopharngeal closure, forking uvula)

what are the 3 signs of submucous cleft palate (SMCP)?

1) blue discoloration (shine light in mouth to see underneath tissue)

2) palpable bony notch at edge of hard palate

3) bifid uvula (issues with velopharyngeal closure, forking uvula)

what are 2 structural cleft palate speech characteritics?

structural: oral fistula, velopharngeal dysfunction

1) nasal emission (on "pressure" consonants such as stops/fricatives/affricates)

2) hypernasality (may be present during production of all speech sounds)

what are 2 compensatory cleft palate speech characteristics?

compensatory: learned missarticulations that may persist post-surgery

1) obstruents produced with a more posterior place of articulation (stops/fricatives/affricates that are palatal, pharyngeal, or glottal; consonants that need complete VP closure to build sufficient intraoral pressure)

2) hypernasal resonance due to persisting inadequate VP movement which can be due to neuromuscular involvement, mislearning, disuse, etc.

based on river's phonemic inventory, describe 2 substitution error patterns which are likely to be observed in River's speech?

1) stopping bc he has little to no fricatives and affricates

2) fronting bc a lot of his post alveolar, palatal, and velar sounds are still developing, therefore he would substitute these with a lot of bilabials and alveolars

of the phonemes absent in River's inventory, which specific sounds would have a significant impact on River's expressive language skills (grammatical morphemes, semantics)? Why?

1) the absence of the /s/ and /z/ phonemes from River's inventory would have a significant impact on his expressive language as he would have trouble with grammatical morphemes such as plurals and possessives

2) the absense of the /r/ would make it difficult for him to correctly say his name and he may have trouble introducing himself as he may say "wivuh" instead

given river's chronological age of 4 years 6 months, do you think he would qualify for speech-language services?

1) river's speech intelligibility is at 50% which is usually where two year olds are, 4 year olds should be at 100%

2) River should have already mastered the /g/ and /k/ by age 4

3) River should have also already mastered the /m/ /n/ /ng/

Assuming that River qualifies for speech-language services, do you think that River's speech sound disorder would be best treated with an articulation or phonological therapy approach?

-phonological approach since River is having trouble mastering 8/9 and currently has not mastered any affricate sounds

-since phonological therapy targets groups of speech sounds, it would be the best approach

-also since river has only mastered velar consonants initial position, he could be exhibiting final consonant deletion or fronting which can also be addressed in the phonological approach

assuming that River did qualify for speech-language services, recommend two initial therapy targets (speech sounds, sound classes, error patterns) that you think would be the most beneficial/effective to remediate

1) easy to teach sound can help visualize certain fricatives like /f,v,s,z/ with tactile cues and verbal instructions

2) minimal pairs (/p/ and /g/)

3) maximal pairs (/r/ with /k/) and (/v/ and /ng/)\

-both of these are personal motivation factors as they are important sounds since they are in river's name

what are standardized assessments and why are they important?

-according to ASHA, these are empirically developed evaluation tools with established reliability and validity typically designed to elicit spontaneous naming based on the presentation of pictures in SSD

-most consonants of GAE are tested in the initial, medial, and final positions of words

-importance: provided a standardized way to assess and compare the relative performance of individuals or groups