Exam 2 PMI Review

Timetable for Speech & Resonance Assessment: Birth to 3

working on quantity (# of words, length of utterance) over quality

Timetable for Speech & Resonance Assessment: Ages 3-4

perform speech/resonance VP comprehensive assessment, stimulibility testing, instrumental evaluation if needed

should have longer sentences and better receptive language

Timetable for Speech and Resonance Assessment: Annually

looking at puberty and how it affects speech (e.g., adenoid shrinkage)

Timetable for Speech & Resonance Assessment: After puberty to 18

screening evaluation every 2 years to make sure treatment is working and they are on the right tract

Why shouldn’t we wait too long to evaluate and treat VPI?

longer someone lives with compensatory errors, it is harder to unlearn

social and emotional aspects of living with VPI

Three steps of the Speech & Resonance Assessment

diagnostic interview, perceptual assessment goals, instrumental assessment

What are the goals of a perceptual assessment?

1. to determine diagnosis and cause

2. obtain info to make reccommendation or develop a treatment plan

What information is obtained during the diagnostic interview?

• parents’ concerns and observations

• medical history, diagnoses, and previous surgeries

• developmental history (speech, motor)

• feeding and oral-motor skills

• evidence of upper airway obstruction and obstructive sleep apnea

• treatment history, including previous therapy

What are we looking for during the language screening?

• risk of langauage delay

• formal vs. informal screening

• if a language disorder is identified → intervention ASAP

Why is a single word articulation test not advised?

• we don’t talk in single words

• limited demand on overall speech system

• target phoneme may be affected through co-articulation

• test is time consuming

What perceptual assessment is the most reliable start?

single sounds

How to test for hypernasality in single sounds

prolongation of a vowel (low v. high vowels)

How to test for nasal emission in single sounds

prolongation of /s/ for both audible and inaudible emission

How to test for hyponasality, cul-de-sac resonance, or airway obstruction in single sounds

prolongation of /m/, if structure is affected or narrowed

How to test for hypernasality in syllables

repeat syllables with low v. high vowels

How to test for nasal emission in syllables

syllables with voiceless sounds combined with low and high vowels

How to test for hyponasality, cul-de-sac resonance, or airway obstruction in syllables

produce /m/ combined with high and low vowels

How to test for hypernasality and nasal emission while counting

60-70 or 66

How to test for hyponasality while counting

90-99 or 99

How to test for speech sound production and resonance and to screen for language?

Load sentences with phonemes that are produced with the same placement

What is the most challenging method of perceptual assessment?

conversation speech, key is finding the client’s interests

What all is being evaluated?

• speech sound production

• nasal emission

• resonance

• phonation

Speech sound production: determine the presence of the following

• placement errors - are they within norms?

• phonological errors - developmental range errors?

• developmental errors

Speech sound production with structural anomalies: determine the presence of the following

• obligatory distortions - nasalization, nasal emission

• compensatory errors - glottal stop, pharyngeal fricative, etc.

Inaudible nasal emission

VPI opening quite large

Audible nasal emission

small VPI opening, lots of friction

Characteristics of nasal emission

• weak or omitted consonants

• short utterance length: counting from 60 to 70 in one breath

• nasal grimace

Nasal emission abnormal structure features (small VP gap)

• occurs inconsistently on all pressure-senstive sounds

• occurs on plosives

• occurence increases in connected speech

• treatment: surgery

Nasal emission abnormal function features (posterior nasal fricative)

• occurs consistently on phonemes particularly /s/ and other sibilants

• never occurs on plosives

• occurs the same in single words and connected speech

• treatment: speech therapy

What aspect is the most important to determine?

resonance

Common resonance rating scales

• seven-point scale

• six-point scale: normal, mild, mild-moderate, moderate, moderate-severe, severe

• four-point scale: normal, mild, moderate, severe

• two-point: normal, abnormal

Why are resonance rating scales unreliable?

• subjective

• inter-rater reliability is low

• severity of resonance can be dependent on content of speech

Does rating resonance severity matter?

not really, treatment is the same

What is more important to determine in terms of resonance?

the type of resonance

What is this?

dental mirror

• used for visual detection

• not very reliable

• can show false positive results

What is this?

air paddle

• used for visual detection

• can help with large openings and inaudible emissions

What is this?

see-scape

• used for visual detection

• very pricey

• single client purpose only

What is this?

a form of tactile detection feeling the vibration of the nasal alae

What is the best form of detection?

auditory

What is this?

cul-de-sac test (nose pinch)

• used for auditory detection

• tests for hypernasality

What is this?

stethoscope

• used for auditory detection

• drum is removed and the tube in inserted into the nasal cavity

What is this?

a listening tube

• used for auditory detection

What is this?

straw

• can function as a listening tube

• used for auditory detection

Recommendations for VPI (insufficiency or incompentency)

• surgery or prosthesis

• speech therapy after correction of VPI for compensatory productions

Recommendations for VP mislearning

speech therapy only

What should always be done as a part of a speech or resonance evaluation?

an orofacial examination

Structural factors often contribute to…

the deviant speech or resonance characteristics

What can we evaluate during the orofacial exam?

oral structures and function, cannot evaluate velopharyngeal structure or function

tools for an intraoral exam

• gloves

• flashlight

• dental mirror

• tongue blades

• sanitizing wipes

• hand sanitizer

How to position a toddler or infant for an orofacial exam

• place in parent’s lap facing the parent

• have the child lay back so the head is over the parent’s or examiner’s knees

• sit across from parent

• close child’s nose if necessary (they will have to open their mouth)

• crying helps (mouth is wide open)

Which structures should you see?

tonsils and palatal arch (vault)

What should we tell the patients to do and say?

• have them say /æ/ (hat) instead of /ɑ/ (father)

• tell them to stick their tongue out and try to touch their chin during phonation

What is palatal palpation used for?

to find the submucous cleft

When is a notch felt?

• when the submucous cleft has extended all the way to the bone (overt cleft)

• should feel the posterior border of the palate (palatal spine)

Examination of the oral cavity using a dental mirror

• to examine the hard palate and see a fistula

• tongue blade can be used to elevate the upper lip off the teeth or pull both lips back

• provides a better view of the teeth and occlusion

Characteristics of oral-motor dysfunction

• drooling

• open-mouth posture and dropped jaw

• anterior tongue position

• history of feeding problems

• difficulty executing oral-motor movements

Key factors of infection control

• frequent handwashing

• using antibacterial soap or antimicrobial gel

• using gloves

• disinfection of materials, equipment, and furniture