L6 Speech Sound Disorder
Introduction to Human Communication and Speech-Language-Hearing Sciences Class 6: Speech Sound Disorder
人際溝通與言語聽覺科學導論 第六課：構音障礙
Presented by: Valerie Pereira, PhD
講者：Valerie Pereira 博士
Location: Faculty of Medicine, The Chinese University of Hong Kong
地點：香港中文大學醫學院
Copyright: © 2017. All Rights Reserved.
版權所有：© 2017。保留所有權利。
Agenda
議程
How we produce speech sounds
我們如何發出語音
Acquisition of speech (and first words)
語音（和第一批詞語）的習得
Speech sounds and the IPA (International Phonetic Alphabet)
語音與國際音標 (IPA)
Speech sound disorder (SSD)
構音障礙 (SSD)
Treatment of SSD - Phonological Impairment
構音障礙的治療 — 語音學障礙
How We Produce Speech Sounds
我們如何發出語音
Overview
概述
The power behind the speech signal involves several processes:
語音信號背後的力量涉及多個過程：
Provides a sound source for voicing.
提供發聲的音源。
Modifies the sound produced at the larynx into sounds we recognize as speech through changes in the vocal tract.
透過聲道的變化，將喉部發出的聲音轉變為我們識別為語音的聲音。
The Vocal Tract
聲道
Structures
結構
Components:
組成部分：
Nasal cavity
鼻腔
Hard palate
硬腭
Oral cavity
口腔
Pharyngeal cavities:
咽腔：
Nasopharynx
鼻咽
Oropharynx
口咽
Laryngopharynx
喉咽
Key Structures for Speech Production:
語音產生關鍵結構：
Lips
嘴唇
Nose and nostrils
鼻子和鼻孔
Teeth
牙齒
Alveolar ridge
齒齦
Soft palate (velum)
軟腭（腭帆）
Uvula
小舌
Tongue
舌頭
Epiglottis
會厭
Larynx
喉頭
Vocal folds
聲帶
Glottis
聲門
Posterior pharyngeal wall (PPW)
咽後壁
Velopharyngeal Function
腭咽功能
Nasal Cavity Modulation:
鼻腔調節：
Soft palate raised for oral sounds
軟腭抬高用於口腔音
Soft palate lowered for nasal sounds
軟腭降低用於鼻音
Resonance
共鳴
Definition
定義
Resonance is the balance of voice involving the oral, nasal, and pharyngeal cavities, in context to what is considered normal for that region.
共鳴是語音涉及口腔、鼻腔和咽腔的平衡，並與該區域的正常情況相符。
Acquisition of Speech and First Words
語音和第一批詞語的習得
Early Vocalizations
早期發聲
0-2 months: Reflexive sounds (crying, fussing, burping)
0-2 個月： 反射性聲音（哭泣、煩躁、打嗝）
1-8 months: Cooing, producing vowel-like sounds that become more adult-like
1-8 個月： 咕咕聲，發出類似元音的聲音，變得更像成人語音
5-10 months: Babbling (e.g., "baba", "googa") becomes more complex
5-10 個月： 牙牙學語（例如「baba」、「googa」）變得更複雜
9-18 months: Jargon - complex babbling with stress and intonation; derived from Stark Assessment of Early Vocal Development-Revised (Nathani, Ertmer & Stark, 2009).
9-18 個月： 行話 — 帶有重音和語調的複雜牙牙學語；源自史塔克早期發聲發展評估修訂版 (Nathani, Ertmer & Stark, 2009)。
First Speech Sounds
第一批語音
Development Timeline
發展時間表
By age 1;0: Infant produces around 5 consonants in initial position
到1;0歲時：嬰兒在詞首位置發出約5個輔音
By age 2;0: Infant produces around 10 consonants in initial position (common sounds include bilabials: /p/, /b/, /m/; and alveolar sounds: /t/, /d/)
到2;0歲時：嬰兒在詞首位置發出約10個輔音（常見的聲音包括雙唇音：/p/、/b/、/m/；以及齒齦音：/t/、/d/）
References: Robb & Bleile (1994), Ttofari-Eecen, Reilly and Eadie (2007)
參考文獻：Robb & Bleile (1994)，Ttofari-Eecen, Reilly and Eadie (2007)
First Words
第一批詞語
Typically emerge around 12 months of age
通常在12 個月大時出現
Common forms include:
常見形式包括：
CV, VC, CVCV (e.g., "wawa")
聲母-韻母 (CV)、韻母-聲母 (VC)、聲母-韻母-聲母-韻母 (CVCV)（例如「wawa」）
Consonants are often those produced at the front of the mouth (e.g., /p/, /b/, /t/, /m/)
輔音通常是在口腔前部發出的聲音（例如：/p/、/b/、/t/、/m/）
There is individual and phonetic variability at this stage, with a limited range of vowels
在此階段存在個體和語音變異性，元音範圍有限
True words are distinguished from babbling (e.g., "wawa" vs. meaning)
真實詞語與牙牙學語區分開來（例如「wawa」與其意義的區別）
Proportion of children producing words:
兒童發出詞語的比例：
Measurements indicating word acquisition percentages at specific ages (data presented with visual aids).
表示在特定年齡詞語習得百分比的測量（數據以視覺輔助呈現）。
Growth of Phonetic Inventory
語音庫的增長
Development Over Time
隨時間的發展
From age 2;0 to 5;0:
從2;0歲到5;0歲：
Children simplify difficult consonants to easier ones, representing phonological processes (Grunwell, 1987)
兒童將難發的輔音簡化為較易發的輔音，這代表了語音學發展過程 (Grunwell, 1987)
Example: /s/ acquired later but /t/ earlier, resulting in 'sun' pronounced as 'tun' or 'soup' as 'toup'
例如：/s/ 習得較晚，而 /t/ 習得較早，導致 'sun' 發音為 'tun' 或 'soup' 發音為 'toup'
Mastery of Speech
語音的掌握
Cantonese Context
廣東話語境
Typical mastery achieved by 6;0 years (To et al., 2013)
通常在6;0歲時實現語音掌握 (To et al., 2013)
Speech Sounds and the IPA
語音與國際音標
Definition
定義
Speech Sounds:
語音：
Consist of consonants and vowels.
由輔音和元音組成。
Focus on pulmonic consonants, produced with air expelled from the lungs.
聚焦於肺部輔音，即透過肺部排出的氣流產生。
Characteristics of Speech Sounds
語音的特徵
Articulation Aspects
發音方面
Place of Articulation:
發音部位：
The point where articulators obstruct the airstream
發音器官阻礙氣流的點
Manner of Articulation:
發音方式：
The technique used to articulate a consonant
發出輔音所使用的技巧
Voicing:
聲帶震動：
Presence or absence of vocal fold vibration
聲帶振動的存在與否
Categories
分類
Place of Articulation
發音部位
Descriptors of Consonants:
輔音描述：
Bilabial: Lips together (e.g., /p/, /b/, /m/)
雙唇音： 雙唇閉合（例如：/p/、/b/、/m/）
Labiodental: Top teeth on bottom lip (e.g., /f/, /v/)
唇齒音： 上齒觸及下唇（例如：/f/、/v/）
Alveolar: Tongue on alveolar ridge (e.g., /t/, /d/, /n/, /s/)
齒齦音： 舌尖觸及齒齦（例如：/t/、/d/、/n/、/s/）
Velar: Back of tongue on hard/soft palate junction (e.g., /k/, /g/)
軟腭音： 舌根觸及硬腭與軟腭交界處（例如：/k/、/g/）
Manner of Articulation
發音方式
Categories Include:
類別包括：
Plosives: Airflow completely stopped then released quickly (e.g., /p/, /t/, /k/)
塞音： 氣流完全停止後迅速釋放（例如：/p/、/t/、/k/）
Fricatives: Airflow constricted to create turbulence (e.g., /f/, /s/, /ʃ/)
擦音： 氣流受限產生湍流（例如：/f/、/s/、/ʃ/）
Nasals: Airflow directed through nasal cavity (e.g., /m/, /n/)
鼻音： 氣流通過鼻腔（例如：/m/、/n/）
Voicing Characteristics
聲帶震動特點
Voiced sounds include all vowels and nasals.
有聲音包括所有元音和鼻音。
The International Phonetic Alphabet (IPA)
國際音標 (IPA)
Purpose and Usage
目的與用法
A special character set used to represent speech sounds as there are more distinctive sounds than letters in the English alphabet.
一種特殊的符號集，用於表示語音，因為發音清晰的聲音比英文字母多。
IPA Chart:
國際音標表：
Represents pulmonic consonants with vocal quality, place, and manner of production.
表示肺部輔音的音質、發音部位和發音方式。
Speech Sound Disorder (SSD)
構音障礙 (SSD)
Overview
概述
SSD is an umbrella term referring to challenges with producing speech sounds.
構音障礙是一個統稱，指產生語音方面的挑戰。
Different classification frameworks exist for this phenomenon.
對於這種現象存在不同的分類框架。
Classification Frameworks
分類框架
RCSLT Framework
英國皇家言語治療師學會框架
Based on CATALISE (Bishop et al., 2017)
基於 CATALISE (Bishop et al., 2017)
ASHA's Framework Classification
美國言語聽力協會分類框架
Breakdown into Functional vs. Organic SSD
分為功能性構音障礙與器質性構音障礙
Functional SSD:
功能性構音障礙：
No known cause; encompasses articulation and phonological speech aspects
無已知原因；涵蓋構音和語音學方面
Organic SSD:
器質性構音障礙：
Involves developmental or acquired issues
涉及發育性或後天性問題
Types of Motor Disorders:運動障礙類型：
Execution (Dysarthria): Neuromuscular issues affecting speech production.
執行（構音困難）： 影響語音產生的神經肌肉問題。
Planning (Apraxia): Cognitive issues related to motor planning for speech.
計劃（語音失用症）： 與語音運動計劃相關的認知問題。
Phonological Impairment
語音學障礙
Cognitive-linguistic challenge in learning phonological systems, characterized by process-based errors (e.g., fronting, stopping).
在學習語音系統方面存在的認知語言挑戰，其特徵是基於過程的錯誤（例如：前化、塞音化）。
Natural Phonology Theory
自然語音學理論
Overview
概述
Theory suggests children modify hard-to-produce sounds into manageable forms (Stampe, 1969, 1979)
理論認為兒童會將難以發出的聲音修正為易於處理的形式 (Stampe, 1969, 1979)
These tangible changes are thought to be innate and require "unlearning."
這些切實的變化被認為是天生的，需要「去學習」。
Although not definitively proven, it assists SLTs in explaining patterns in disordered speech.
儘管尚未被明確證實，但它有助於言語治療師解釋構音障礙語音中的模式。
Phonological Processes
語音學過程
Types
類型
Common Processes Discussed:
討論的常見過程：
Fronting
前化
Cluster Reduction
複輔音簡化
Stopping
塞音化
Gliding
滑音化
Final Consonant Deletion
韻尾輔音省略
Deaffrication
塞擦音擦音化
Example - Fronting Process
範例 — 前化過程
A child produces velar consonants like /k/ as alveolar stops [t] or [d].
兒童將軟腭輔音（如 /k/）發音為齒齦塞音 [t] 或 [d]。
Voicing feature remains unaffected.
聲帶震動特徵不受影響。
Example Application in Cantonese:
廣東話應用範例：
/k/ → [t] in words such as 鼓 (drum) /ku2/ becomes [tu2].
詞語如鼓 /ku2/ 變成 [tu2] 時，/k/ → [t]。
Example - Stopping Process
範例 — 塞音化過程
In early speech, children may replace fricatives such as /s/ or /z/ with plosives [t] or [d], maintaining voicing characteristics.
在早期語音中，兒童可能會將擦音（如 /s/ 或 /z/）替換為塞音 [t] 或 [d]，同時保持聲帶震動特徵。
Cantonese Dialectal Processes
廣東話方言過程
Specific phonological processes include:
特定的語音學過程包括：
Deaspiration: Aspirated consonants losing their aspiration features while being produced.
不送氣化：送氣輔音在發音時失去其送氣特徵。
Delabialization: Failure to apply lip-rounding in labiovelar sounds.
去唇化：唇軟腭音未能應用圓唇動作。
Phonological Intervention Approaches
語音學干預方法
Overview
概述
Types of Interventions
干預類型
Meaningful Minimal Pair Intervention
有意義最小對語音干預
Perception-Production Minimal Pair Intervention
感知-產生最小對語音干預
Maximal Oppositions & Treatment of the Empty Set Approaches
最大對立與空集處理方法
Multiple Oppositions Methods
多重對立方法
Metaphon Approaches
語音意識訓練方法
Cycles for Phonological Remediation
語音矯正循環法
Stimulability Interventions
可激發性干預
Speech Perception Interventions
語音感知干預
Core Vocabulary Intervention (CVT) for Inconsistent Speech Disorders
針對不一致性構音障礙的核心詞彙干預 (CVT)
Nonlinear phonological interventions
非線性語音學干預
Simulated Case Example
模擬病例範例
Subject: Male, 4;1
研究對象： 男性，4歲1個月
Observation: Many sounds unclear.
觀察： 許多聲音不清晰。
Initial Assessment: Stopping of /s/ to [t], /z/ to [d], ‘ch’/tʃ/ to [t].
初步評估： /s/ 塞音化為 [t]， /z/ 塞音化為 [d]，‘ch’/tʃ/ 塞音化為 [t]。
Meaningful Minimal Pair Intervention
有意義最小對語音干預
Example:
範例：
A child who cannot differentiate /s/ might say 'sew' incorrectly as [təʊ], leading to misunderstanding.
一個無法區分 /s/ 的兒童可能會錯誤地將 'sew' 說成 [təʊ]，導致誤解。
The intervention aims to confront this breakdown and improve clarity.
干預旨在應對這種錯誤並提高清晰度。
Phases of Intervention
干預階段
Familiarization with Picture Sets:
熟悉圖片集：
Listening and Picking Up: Child identifies intended sounds from certain pictures.
聆聽和選取： 兒童從某些圖片中識別意圖的聲音。
Production: The child attempts to produce phonemes correctly in the context of word pairs.
發音： 兒童嘗試在詞對的語境中正確發出音位。
Teaching Cues for /s/
/s/ 的教學提示
Pragmatic Cue: Prompt for clarification when unclear.
語用提示： 當不清楚時，提示澄清。
Verbal-Phonetic Cue: Guidance on tongue positioning for /s/.
口語-語音提示： /s/ 的舌頭位置指導。
Visual-Phonetic Cue: Demonstration of sound articulation.
視覺-語音提示： 聲音發音的演示。
Tactile-Phonetic Cue: Physical feedback for articulation.
觸覺-語音提示： 發音的身體反饋。
Metaphonological Cue: Describe the sound (e.g., 'hissing like a snake').
元語音學提示： 描述聲音（例如，「像蛇一樣嘶嘶作響」）。
Non-Speech Oro-Motor Exercises
非語音口腔運動練習
Overview
概述
Non-speech oral-motor exercises (NSOME) focused on muscle strength training (e.g., blowing, sucking, tongue movements) are not recommended for phonological impairment therapy.
專注於肌肉力量訓練的非語音口腔運動練習（例如：吹氣、吸吮、舌頭運動）不建議用於語音學障礙治療。
Evidence Against NSOME Efficacy
不支持非語音口腔運動練習效用的證據
1. NSOME do not increase articulatory strength relevant to speech sounds.
1. 非語音口腔運動練習不會增加與語音相關的發音力量。
2. They lack specificity to speech movements.
2. 它們缺乏語音運動的特異性。
3. There is no strong evidence to support their efficacy in treating SSD.
3. 沒有強有力的證據支持它們在治療構音障礙方面的效用。
Conclusion
結論
Final Note: Understanding the nuances of speech production and disorders is key, with an emphasis on linguistic challenges over motor weaknesses in speech therapy.
最後說明： 理解語音產生和障礙的細微差別是關鍵，言語治療中應強調語言挑戰而非運動弱點。
Copyright: © 2017. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong
版權所有：© 201