Bernthal Pg 171-175 Screening for SSD

Assessment of Velopharyngeal Function

  • Passavant's Pad

    • Present during sustained phonation in individuals, notably those with cleft palates (appears in ~1/3 of cases).

    • Its presence may indicate a compensatory mechanism, signaling potential velopharyngeal valving issues.

    • In surgical decisions (such as adenoidectomy), the need for adenoidal tissue for closure is considered.

  • Instrumental Measures for Assessment

    • Various instrumental methods supplement clinical assessments of velopharyngeal function.

    • Inadequate velopharyngeal function can lead to issues such as:

      • Hypernasal resonance

      • Weak production of pressured consonants (stops, fricatives, affricates)

      • Nasal air emission

    • Examples of assessment tools include:

      • Nasometer

      • Videofluoroscopy

      • Nasopharyngoscopy

      • Aerodynamic measures

The Role of the Tongue in Articulation

  • Importance of Tongue Movements

    • The tongue is a primary articulator capable of compensating for oral cavity variations.

    • Macroglossia: abnormally large tongue; historically associated with Down syndrome, but often the tongue size is normal in this population due to low muscle tone and small oral cavity (relative macroglossia).

    • Microglossia: abnormally small tongue; rarely causes speech issues.

  • Speech vs. Nonspeech Tongue Movements

    • Tongue movements for speech differ from nonspeech activities.

    • Protruding the tongue and lateral movements can reveal motor control issues.

  • Diadochokinetic Tasks

    • Involves rapid speech movements (e.g., /pA p^ pA/).

    • Syllable production rates may not correlate with articulatory proficiency unless there is a gross motor issue.

    • Focus should be on the pattern of movement and consistency in contacts during tasks.

  • Short Lingual Frenum

    • Can restrict tongue tip movement; however, most individuals can communicate effectively despite its length.

    • If the client can reach the alveolar ridge with the tongue tip, frenum length is likely appropriate; otherwise, surgical intervention might be assessed.

Options in Oral Cavity Examination

  • Considerations for clinicians noticing structural/function inadequacies contributing to speech errors:

    1. Refer to other professionals (e.g., otolaryngologist, orthodontist, cleft palate team).

    2. Engage in further observation and testing.

    3. Provide compensatory or remedial instruction.

Audiological Screening

  • Purpose: To detect auditory function loss that may cause speech sound disorders (SSD).

  • Typically conducted prior to phonological assessment using:

    • Pure tone screening at 500, 1,000, 2,000, and 4,000 Hz, primarily at 20 dB HL (adjusted for ambient noise).

    • Impedance Audiometry: measures eardrum compliance and middle-ear pressure, providing insights on tympanic membrane function via acoustic reflex assessment.

    • Referral to an audiologist is recommended if screening fails.

Speech Sound Perception/Discrimination Testing

  • Historical Context: Early clinicians linked speech sound errors to perception issues.

  • Shift in Practice: General speech sound discrimination tests have become less common; focused assessments are favored now.

Speech Production-Perception Tasks

  • Two Approaches for Assessment:

    1. Judgment Tasks

      • Involves presenting words for the child to judge their correctness based on their performance.

    2. Contrast Testing

      • The child selects from two pictures which aligns with the spoken word, reflecting contrasts in sounds.

  • Effective Assessment Design

    • Identify target sounds, usual errors, and control sounds to construct specific auditory tests.

    • Analyze responses to assess perceptual abilities effectively.

Conclusion

  • Speech sound assessment includes both screening and comprehensive evaluations.

  • A comprehensive battery entails:

    • Connected speech and single-word sampling

    • Stimulability and contextual testing

    • Additional procedures like case history, oral cavity examination, audiological screening, and perceptual testing.

  • Data gathered is crucial for interpretation during subsequent evaluations.