Perlocutionary Period 0-8 months - unintentional communication
Reflexive Vocalizations 0-2 months
sounds reflect automatic responses of body that depend on the anatomy of the child (e.g., burping, crying, etc.)
nasalized vowel-like sounds w/ minimal resonance
Cooing 2-4 months
sounds made in the back of mouth
back vowels
Vocal Play 4-6 months
raspberries, growls, squeaks
begin to see CV syllables
Babbling 6+
Reduplicated Babbling - CVCV syllable chains (e.g., “dada”)
Variegated Babbling - CV chains (w/ variations in C’s & V’s)
Illocutionary Period 9-12 months - intentional communication
Emergence of Speech Patterns 9+ months
jargon, longer strips of variegated babbling
babbling is accompanied by sentence like intonation patterns
Phonetically Consistent Forms (PCFs)
Receptive Milestones
Birth-3 months
reacts to loud sounds
smiles to familiar voices
quiets to familiar speakers
4-6 months
recognizes changes in vocal tone
eyes move toward sounds
responds to toys w/ noise
7-12 months
recognizes and turns to name
comprehension of simple words
plays games, listens to songs
1-2 years
follows simple 1-step directions
understands simple questions
points to objects/pictures named
2-3 years
follows 2-step directions
simples opposites (e.g., big vs. small)
easily comprehends new words
3-4 years
simple concepts (e.g., colors, shapes)
responds to name (from other room)
understands family words (e.g., sister)
4-5 years
understands order words (e.g., first)
understands time words (e.g., today)
follows longer multi-step directions
Expressive Milestones
Birth-3 months
cries for basic needs
begins to smile at familiar people
begins to make cooing sounds
4-6 months
babbles and coos during play
sounds for various emotions
begins to laugh
7-12 months
shows objects by pointing
begins to use gestures (e.g., waving)
first words emerge (around 12 months)
1-2 years
begins to put two words together
asks simple questions
many new words emerge
2-3 years
begins to put three words together
asks “Why?”
simple prepositions (e.g., in, on)
3-4 years
puts up to four words together
asks “when?” & “why?”
simple pronouns & some plurals (-s)
4-5 years
tells short stories, holds convos
code switches (based on listener, place)
naming of letters, numbers
Brown’s Stages
Stage 1: 12-26 months
about 50 words in vocabulary
basic phrases
ex. “more juice/my doll”
Stage 2: 27-30 months
present progressive -ing
“in” and “on”
regular plural -s
“man running/in house/on book/my kids”
Stage 3: 31-34 months
irregular past tense
possessive ‘s
uncontractible copula
“me drew/daddy’s hat/ her is sick”
Stage 4: 35-40 months
articles (a, the)
regular past tense
third person regular present tense
“the bucket/she shopped/he runs”
Stage 5: 41-46+ months
third person irregular
uncontractible auxiliary
contractible copula
contractible auxiliary
“doggy does tricks/ he was jumping/she’s happy/she’s dancing”
How do you calculate mean length of utterance aka MLU (average number of morphemes per utterance)?
MLU = total # of morphemes / total # of utterances
White Matter → there are cortical changes
Gray Matter → volume loss
Presbycusis:
age-related hearing loss
sensorineural hearing loss
high frequency loss (hair cell damage)
Presbyopia:
age-related vision loss
farsightedness
treatment: reading glasses
Presbyphonia:
age-related voice changes
weaker, breathy voice; more breaks/stops
higher pitch in men, lower pitch in woman
reduced loudness, laryngeal tension, tremor
Presbyphagia:
age-related swallow changes
decreased strength and sensation (taste)
slower swallow response
laryngeal penetration is more common
Motor Changes:
general slowing of motor skills
voice changes
smaller, slower, more fatigued muscles
other health issues exacerbate motor
Cognitive Changes:
slowed processing
langauge typically remains intact
difficulty recalling new info/specific details
difficulty with multitasking/executive function
Language - social, rule-governed tool used to send and receive messages
Receptive Language - language comprehension
listening and reading
develops before expression
understanding of langauge
vocabulary, questions, concepts, directions
Language Production - langauge production
speaking and writing
expression of wants and needs
words, nonverbal communication
gestures, pointing, expressions, grammar
Form:
Phonology - speech sounds
Syntax - word order
Morphology - word endings
Content:
Semantics - word meanings
vocabulary
how word meanings link
Use:
Pragmatics: social rules
matching language & situation
Nature - Nativist-Generative View (Chomsky):
langauge is innate and pre-specified
we are born with LAD (acquisition device)
language is separate from other cognitive systems
Limitations:
non-literal langauge (i.e., idioms); strict focus on syntax; no single grammar to account for all languages
no evidence that children need adult-like rules to acquire language
Evidence supporting Nature:
deaf babies babble; speech ang langauge deficits may be inheritable
children follow sequence of developmental milestones
langauge aspects learned without direct instruction (e.g., grammar rules)
we are born with a Language Acquisition Device (LAD) which determines how we learn langauge
Nurture - Constructionist-Interactionist View:
environment guides language
no processor in brain specific for langauge
can’t separate langauge from cognitive systems
Evidence for Nurture - operant conditioning
Other Langauge Theories:
Cognitive Theory (Piaget) -
children learn langauge like other cognitive skills (concepts first, then langauge)
language is made possible by cognitive and other intellectual processes
observe child in play to determine level of representational thought
Semantic Theory (Filmore, Bloom) -
interpretation of messages requires consideration of meaning
acquisition stimulated by child’s desire to communicate and knowledge
Behavioral Theory (Skinner) -
children learn language through conditioning (only what they are exposed to)
stimulus-response drive language acquisition; Drill & practice → reinforcement
Social Interactionism
encourage social interactions; desire to communication & use drives acquisition
incorporate caregivers and multiple environments into learning
Emergentist Theory
data and pattern driven, child’s ability to use cues develops over time
neurologically based
Critical Period Hypothesis - MUST have adequate stimuli before “critical age” (5-7 years old) or full langauge command cannot be achieved
Phonology
shortest optimal/critical period
need exposure to phonology in first years of life to have native accent
0-3 years: p, m, h, n, w
0-4 years: b
2-4 years: k, g, d
2-6 years: t, ng
2.5-4 years: f, y
3-6 years: r, l
3-8 years: s
3.5-7 years: tsh, sh
3.5-8 years: zj
4-7 years: j
4-8 years: v
4.5-7 years: th voiced
5-8 years: th voiceless
6-8 years: dj
Classification: consonantal sounds (in English) are classified by 3 dimensions…
Voice - activity of vocal folds
Place - point of contact where sound is produced
Manner - configuration and interaction between articulators
Acoustic Theory of Sound Production
Source-Filter Theory - sound source filtered and shaped by resonant vocal tract
Sound Sources: Glottal Source and Supraglottal source
Filter
Vocal Tract: Oral Tract and Nasal Tract
Speech Sounds: Distinctive Features
Sound Sources:
Sonorants - produced with uninterrupted air
Consonantal - partial or complete obstruction of airflow
Continuants - flow of air is not blocked at any point
Sibilants - high frequency “hissing” sounds, air forced through narrow opening
Stridents - production with constriction, airstream hits 2 surfaces (intense noise)
Obstruents - produced by some type of air obstruction/constriction
Speech Sounds:
Stops - complete vocal tract closure (pressure buildup) - sudden release
Fricatives - partial blockage of vocal tract, air forced through narrow channel
Affricates - start as a stop (air builds up), releases through narrow channel (fricative)
Nasals - Valium lowers and air flows through nasal cavity (closure of oral cavity)
Liquids - Airstream flows through sides of tongue (tip to mid alveolar ridge)
Glides - consonants with no stop or friction
Filter:
Bilabial - produced by using both lips
Labiodental - produced using both lower lip and upper front teeth
Interdental - tongue tip on/near/between inner surface of upper teeth
Alveolar - tip of tongue touches Ridge immediately behind upper front teeth
Palatal - front part of tongue to/near hard palate at the roof of the mouth
Velar - back of tongue to/near velum/soft palate
Glottal - produced by air passing through windpipe through vocal folds
Vocal Tract from most open to closed:
Vowels and diphthongs
Liquids and Glides
Nasals
Stops,fricatives and affricates
Vowels and Diphthongs - produced by selectively amplifying vocal tract
Produces distinctive formant patterns which listeners perceive
F1 and F2 are important for perception
Classified as: front, entral, back in high, middle, low
Liquids and Glides - produced with some constriction ( oral semi-vowels, vowel-like)
Liquids - /r/ palatal retroflex ; /l/ alveolar and only lateral in English
Glides - /j/ Palatal, High tongue ; /w/ starts high back position
Nasals - produced by occlusion of vocal tract and an open nasal port
Air flows through nasal cavity
Lower resonant frequencies; reduced intensity (nasal murmur)
Fricatives - produced by air flow through narrow constriction
Creates turbulent noise
Obstruent sounds
Affricates - produced by total occlusion of vocal tract and a slow release
Creates a noise burst, may also be called plosives
Perceived based on: frequencies of bursts and formant transitions
F2 and F3 (burst to vowel)
Extralinguistic:
Metalinguistic - study of language and relationship with other behaviors
Paralinguistic - communication aspects are not words (i.e., gestures)
Non-linguistic - sounds not relating to language (i.e., laughing)
Speech
Respiration - breathing, power and energy
Phonation - creation of voice sounds; vocal fold vibration
Resonation - modification of phonation; cavities and structures
Articulation - manipulation into distinct sounds and words
Language
Form
Phonology - sounds (no meaning attributed to individual sounds)
Syntax - word order (words strung together to form sentences)
Morphology - word endings (phoneme strings, smallest unit of meaning)
Four systems of speech production:
Respiration - power and energy for speech; 2 phases (inhalation and exhalation_
Inhalation - diaphragm contracts an air rushes into lungs; abdomen expands and then chest expands
Exhalation - diaphragm relaxes forcing air back out of lungs
Phonation - rapid vibration of vocal Folds; creates acoustic energy (i.e., voice)
Pitch - frequency of vibration
Loudness - intensity of sound
Quality - the sound quality of voice
Resignation - modification of voice (i.e., by various cavities and structures)
Pharynx, nasopharynx, nasal cavity, oral cavity
Articulation - redefining and manipulating phonation into distinct sounds
Lips, teeth, alveolar Ridge, tongue, hard palate, soft palate/velum
Acoustics - branch of physics that studies properties of sounds
Acoustically
Fundamental frequency (Hz)
Intensity (dB)
Time
Physiologically
Endoscopy
Fluorography
Oral Facial sensory motor
Perceptually
Articulation testing
Listening to speech sounds
Spontaneous or prompted
Inertia - resistance when force is exerted upon an object
Elasticity - tendency for an object to return to its original state
Cycle - each individual vibration
Period - Time of one full cycle
Frequency - number of Cycles in one second
Amplitude - maximum displacement of particles in a medium
Perceptually related to intensity / loudness, not one-on-one relationship
Frequency - rate at which object vibrates; number cycles in one second (Hz)
Need period of wave to figure out the frequency
Pure Tones - has only one frequency
sinusoidal motion or simple harmonic motion
Sine Waves - periodic, cycles will repeat themselves identically
Complex Periodic Waves:
Complex - more than one frequency present
Periodic - The complex pattern repeats over time
Complex Aperiodic Waves:
Complex - more than one frequency present
Aperiodic - no cyclical or pattern behavior
Fundamental Frequency - lowest pure tone component of sound
Partials / Overtones - all other frequencies present in a sound excluding fundamental
Harmonics - whole number multiples of fundamental frequency
Nerves - axons bound together by connective tissue
Group of fibers outside the CNS
Spinal nerves contain fibers of sensory and motor neurons
Neurons - individual cells in the brain (dendrites, axons, cellbody)
Tracts - group of fibers inside the CNS (spinal tracts carry info up/down the spinal cord, to and from the brain)
Efferent - motor nerve
brain sends signal down to the nerve to innervate a muscle (exits)
Afferent - sensory nerve
signal comes up from sensory organ via nerve to brain (arrives)
Pyramidal - tracts that originate in cerebral cortex carry fibers to spinal cord/brainstem
voluntary control (body and face muscles)
Extrapyramidal - tracts that originate in the brainstem carry fibers to spinal cord
involuntary & automatic control (tone, balance, posture, etc.)
Upper Motor Neuron (UMN) - found in cerebral cortex/brainstem
transmits nerve impulses from brain to lower motor neurons
Lower Motor Neuron (LMN) - found in brainstem/spinal cord
transmit nerve impulses from upper motor neurons to muscles
Corticospinal - synapse/terminate in spinal cord
controls movements in limbs & trunk
corticospinal - spinal cord
Corticobulbar - synapse/terminate in brainstem
controls muscles of face, head, neck
corticobulbar - brainstem
Positional Terms
Unilateral - one side innervating
Bilateral - both sides innervating
Ipsilateral - same side of the body
Contralateral - opposite side of the body
Proximal - near given position
Distal - away from given position
Anterior - in front of
Posterior - behind
Superior - above
Inferior - below
Rostral - front, towards the nose
Caudal - back, towards the tail
Look at page 32 and 33
What are the major divisions of the brain? Forebrain, Midbrain, Hindbrain (p. 34)
Forebrain - processes sensory info, reasoning/problem solving, automatic motor functions; largest brain division; has two subdivisions
Telencephalon - cerebral cortex (divided into 4 major lobes)
Frontal, Parietal, Temporal, Occipital
Diencephalon - connects endocrine with nervous system
Thalamus, Hypothalamus, Pineal Gland
Midbrain - regulates movement, processes auditory and visual info
connects forebrain to the hindbrain; 2 main parts: Tectum & Paired Cerebral Peduncles
Hindbrain - regulates autonomic functions, balance, equilibrium, relay of sensory info
2 Subdivisions:
Metencephalon - pons and cerebellum
Myelencephalon - medulla oblongata
Cerebrum - thinking portion of the brain; most complex cognitive functions
Location - front area of skill, composed of two hemispheres (left/right)
Brainstem - automatic reflexes/vegetative functions (e.g., breathing, heart rate, etc.)
base of brain-cerebrum juncture + spinal cord; midbrain, pons & medulla
Cerebellum - voluntary movements; balance, coordination, posture, attention
hangs off back of brainstem under occipital lobe
Medulla - regulates respiration, heart rate + reflexes such as vomiting, swallowing
lower portion of brainstem, below pons
Pons - attachment between cerebellum and rest of CNS
middle portion of brainstem
Midbrain - houses substantial nigra (production of neurotransmitter - dopamine)
upper (superior) most part of brainstem
Basal Ganglia - fine0tunes voluntary body movements, motor coordination, posture
deep within body vertebral column, PNS begins here
Spinal Cord - allows afferent impulses to transmit to brain + efferent from brain→body
housed within body vertebral column, PNS begins here
Thalamus - relay center for sensory signals; and also motor
top of brainstem; core of diencephalon
Hypothalamus - homeostasis, regulates hunger/thirst, pain/pleasure, anger/aggression
below thalamus; posterior to optic chiasm
Hippocampus - responsible for new memories, emotions, spatial navigation
within inferior and medial section of temporal lobe
Amygdala - responsible for emotions, arousal, motivation
Nuclei, located within temporal lobes
Heschl’s Gyrus - auditory processing
Brodmann area 41
Angular Gyrus - involved in semantic processing, language and cognition
area 39
Frontal lobe - primary motor area, controls executive function + motor
Broca’s area (speech production), memory, attention, motivation
Parietal - sensory motor area
spatial reasoning, math, reading, hearing, smell, taste, touch
Occipital - visual area
receives visual cues from opposite visual field, color identification
Temporal - auditory processing and comprehension
Wernicke’s area (language comprehension/processing), memory
Left Hemisphere - language dominant hemisphere
damage here can cause Aphasia
Right Hemisphere - supporting language hemisphere
damage here can cause higher-order language and perceptual damage
Circle of Willis - connects the internal carotid and vertebral/basilar system
Anterior Cerebral Artery - extends upward and forward from internal carotid artery
blood supply to → frontal & parietal lobes, basal ganglia, and corpus callosum
stroke in ACA can cause opposite leg weakness
Middle Cerebral Artery - largest branch of internal carotid
blood supply to → Broca’s and Wernicke’s, temporal lobe, and primary motor cortex
MCA is the artery that is most often occluded in a stroke
Posterior Cerebral Artery - stem from basilar artery (in most people)
blood supply to → occipital lobes, cerebellum, and inferior temporal
CVA PCA: usually 2* to embolism from lower segments of vertebral heart
Commissural Fibers - inter hemispheric (connects right ad left hemispheres)
interconnect identical and corresponding area of 2 cerebral hemispheres
Association Fibers - intra hemispheric (within the same hemisphere)
connect different regions of the cerebral cortex within same hemisphere
Projection Fibers - fibers that leave cerebral white matter
connect cerebral cortex to the brainstem and below
There are 12 Cranial Nerves → but there are 6 main important Cranial Nerves needed for speech
Cranial Nerve 5 Trigeminal
Origin → pons
Sensory - sensation for face, lips, jaw
Motor - muscles for mastication
Cranial Nerve 7 Facial
Origin → pons
Sensory - taste (anterior 2/3 of tongue)
Motor - lips, facial movement, expression
Cranial Nerve 9 Glossopharyngeal
Origin → medulla
Sensory - taste (posterior 1/3 of tongue)
Motor - pharynx movement (superior portion)
Cranial Nerve 10 Vagus
Origin → medulla
Sensory - larynx, pharynx, abdominal viscera
Motor - larynx, pharynx, velum movement
Cranial Nerve 11 Accessory
Origin → medulla and spinal cord
motor - shoulder, neck, also assists vagus nerve movement
Cranial Nerve 12 Hypoglossal
Origin → medulla
motor - tongue movement
There are four groups of muscles responsible for chewing:
Masseter Muscle - connects mandible and cheekbone
elevates mandible and closes the mouth
Temporalis Muscle - large, fan-shaped muscle
retracts and elevates mandible, side to side movement
Medial Pterygoid - connects mandible with maxilla, sphenoid, and palatine bones
elevates mandible and protrudes the jaw
Lateral Pterygoid - two-headed muscle located in infra temporal fossa of skull
depresses and protrudes mandible to open mouth
The Elevator Muscles are… Masseter, Temporalis, Medial Pterygoid
Respiration - gas exchange; the process of inspiration and exhalation
Lungs - porous, spongy organ of breathing located in thoracic cavity
Skeletal Structure - vertebral column
Vegetative Breathing - goal of life is sustenance, automatic and consistent
Speech Breathing - expiration more important than inspiration, speak on exhale
Ventilation - the process of inspiration and expiration
Process of Inspiration
→ air enters the lungs
→ contraction of inspiratory muscles
diaphragm contacts and pulls downward
external intercostal muscles contract
thoracic cavity expands
volume increases/pressure decreases
Air rushes into the lungs
through nose/mouth, down pharynx (between open vocal folds) → down through trachea → into the lungs
Process of Expiration
→ air exits the lungs
→ relaxation of inspiration muscles
diaphragm relaxes and rises
internal intercostal muscles relax
thoracic cavity collapses
volume decreases/pressure increases
air rushes out of the lungs
lungs recoil, chest wall returns back to its original state, and air expelled out of lungs
Larynx - organ at the top of the neck involved in breathing, sound production, and aspiration prevention
Regions / Cartilages of the Larynx
Supraglottis (area above the vocal folds)
Cricoid - most inferior cartilage, ring-shaped; unpaired cartilage
Arytenoid - only paired major cartilage
Glottis (contains true vocal folds)
Thyroid - largest cartilage, Adam’s apple; unpaired cartilage
Corniculate - attach to apex of arytenoid cartilages; paired cartilage
Subglottis (area below the vocal folds)
Epiglottis - leaf shaped, protects airway during swallow; unpaired cartilage
Cuneiform - does not attach to any other cartilages (paired cartilage)
Muscles of the Larynx:
Extrinsic Muscles
Suprahyoid and Stylopharyngeus → elevate the larynx
Infrahyoid → depresses the larynx
Intrinsic Muscles
Posterior cricoarytenoid → VF ABduction
Lateral Cricoarytenoid, Transverse Arytenoid, Oblique Arytenoid, Cricothyroid, Thyroarytenoid → VF ADDuction
Vocal Folds (VF) - modulate the flow of air being expelled from the lungs during phonation
muscles do not actually vibrate → aerodynamic forces do → air pressure is the primary force
There are 3 pairs of vocal folds:
True Vocal Folds
Aryepiglottic Folds
Ventricular (False) Folds
Vocal Fold Vibration (one complete cycle)
vocal folds are adducted (closed), air pressure builds up below them
as air pressure rises, bottom of folds are forced apart
pressure the forces folds apart at middle, then at top, until air freely flows
presure decreases
as pressure decreases, folds move toward midline (bottom first and top last)
ex. A complete cycle of vocal fold vibration is like a set of swinging doors. As pressure builds behind them (air pressure), the bottom opens first, followed by the middle and top, until they're fully open and air flows through. When the pressure drops, the doors swing back, closing from the bottom to the top, repeating the process.
Aryepiglottic Folds - tips of arytenoids to the larynx; separates laryngeal vestibule from pharynx
Velopharyngeal Closure - contraction of… Palatoglossus, Tensor Veli, Palatini, Levator Veli Palatini
Bernoulli Effect - change in pressures that pull vocal folds together caused by Bernoulli Effect; speed of air increases and “sucks” vocal folds towards one another → closure of folds
Mucosal Wave - wave-like motion of vocal fold cover; necessary for vibration → phonation
Soft Palate - mobile flap of soft tissue; elevated during swallow to prevent food from entering nasopharynx
Pharynx - part of digestive + respiratory systems; connects nose, mouth, and throat
Nasopharynx - upper part of pharynx; connects nasal cavity and throat
Oropharynx - middle part of pharynx; starts at soft palate and goes down to base of tongue
Laryngopharynx - lower part of pharynx; above larynx and below oropharynx
Epiglottis - leaf-shaped flap; flaps to cover glottis of larynx during swallow; main function is to prevent aspiration
Between-Subject Designs - performances of separate groups of subjects are measured and comparisons are then made between the two groups
Subject-Randomization - each subject has equal probability of being assigned to either the experimental or control group
Subject Matching - experimenter purposely attempts to match members of two groups based on all extraneous variables relevant to the experiment
Within-Subject Designs - performances of same group is compared in different conditions and/or in different situations; sequencing effect may occur
Subject Randomization - presentation of the experimental treatment conditions to the subjects in random order
Counterbalancing - technique that enables researcher to be able to control and measure sequencing effects by testing different participants in different orders
Sequencing Effect - may occur when subjects participate in several conditions (i.e., subjects participation in an earlier condition may affect their performance in subsequent)
Sampling Method - a technique of selecting individuals or a group of individuals from a population to use in research studies (probability and non-probability samples)
Probability Samples:
Simple Random Sampling - every member of population chosen randomly and has an equal chance
Systematic Sampling - sample members are chosen at regular intervals every nth member
Stratified Random Sampling - population divided into subgroups before random selection
Cluster Sampling - population divided into clusters based on demographics (e.g., location)
Multistage Sampling - every member of population chosen randomly and has an equal chance
Non-Probability Samples
Purposive Sampling - specific individuals are chosen to participate
Convenience Sampling - depends on ease of access and proximity
What are the key steps to EBP?
Frame clinical question
Find the evidence
Asses the evidence
Make clinical decision
Informed Clinical Decisions:
internal clinical evidence
external research evidence
patient preferences
Credibility of Evidence levels and Types
Level 1 - systematic review/meta-analysis of all relevant RCTs; 3+ good quality randomized controlled trials with similar results
Level 2 - 1+ well designed randomized controlled trial(s)
Level 3 - well designed non-randomized quasi-experimental studies
Level 4 - well designed case-control or cohort studies
Level 5 - systematic reviews of descriptive and qualitative studies
Level 6 - single descriptive or qualitive study
Level 7 - expert opinion and/or reports of expert committees
ICF - International Classification of Functioning, Disability, and Health → developed by the World Health Organization (WHO) and published in 2001
Screening can involve…
Articulation and phonology
language and cognition
fluency and stuttering
voice and resonance
motor speech
neurogenic disorders
dysphagia and swallowing disorders
Assessment can involve…
case history
interview
oro-facial exam
informal testing
hearing screening
ongoing evaluation
formal standardized testing
What does a Case History entail? Medical and personal background history used to analyze & diagnose diseases, disorders, etc.
What do we want to know?
Onset and Development
age of onset
other conditions during onset
length since onset
variations since onset
awareness and reactions of onset
Medical History
history of hospitalizations
history of surgeries
medication list
vision, hearing, and motor abilities
Family History
blood relatives history of any related SLP conditions
Speech-Language Disorders and Concerns
previous speech/language therapy and outcomes
reason for SLP referral
Educational and Social History
highest level of education
jobs and/or hobbies
primary, secondary language(s) spoken
Prior Level of Function
if new (e.g., acute CVA) or not new onset
change(s) in function from baseline
who patient lives with, ADLs, daily communication needs, etc.
Signs and Symptoms → identify signs and symptoms such as…
difficulty chewing and/or swallowing
difficulty expressing self and/or understanding langauge
problems with memory a/o problem solving/reasoning
problems w/ attention a/o concentration
problems w/ reading a/o writing
difficulty w/ word retrieval and word finding
difficulty w/ topic maintenance and following directions
Speech and Language Sampling - provides diagnostic information and guides treatment plans
Analyzing the sample →
articulation errors and distortions
rate of speech
language errors and pattern of errors
speech intelligibility
Expressive Language
Morphology, Semantics, and Syntax
point to more than one of an object (plurals)
follow oral directions (varying # of steps)
verbalize/gesture serial tasks (e.g., counting)
name objects, pictures, etc.
Semantics/Syntax
identify spatial concepts (E.g., over/under)
Receptive Language
Morphology, Semantics, and Syntax
describe pictures
describe and tell stories
describe objects by features or relationships
explain sequence of events for daily tasks
role play scenarios
describe solutions to problems or situations
Kindergarten - 1st grade
Delve deeper into langauge pyramid
phonology, morphology, semantics, syntax in expressive and receptive language
analysis used for younger children will applies except for MLU (not valid after the age of 5 yrs./o.)
C-Unit analysis - conversational analysis for school aged
T-Unit monologue analysis for school aged
Older children
Analyze more global measures
receptive/general comprehension (listening and reading, expressive (pragmatics)
evaluation of pragmatics
appropriate attention of prosody
topic initiation and maintenance
conversational repairs and turn taking
evaluation of narratives
personal narratives, retelling stories, appropriate sequencing and details, etc.
What do we want for a comprehensive assessment?
Case History
Hearing Screening
Oral Facial Sensory Motor Exam (OFSME)
Formal Assessment
Standardized methods
Popular assessments:
Goldman-Fristoe Test of Articulation (GFTA-3)
Khan-Lewis Phonological Analysis (KPLA)
Informal Assessments
Identify strengths and weaknesses
Speech-language sample
Phonetic Inventory
explain which position(s) sound was seen during testing
assess and identify stimulable sounds
Speech Intelligibility
24 mo: 50%
36 mo: 75%
48 mo: 100%
Rate and prosody
Number, type, and consistency of errors (classify based on most appropriate system)
Traditional SODA errors
substitutions
omissions
distortions
additions
Features
voice
place
manner
Phonological processes
typical vs atypical
typical vs typical but no longer age-appropriate
Evaluate etiology of articulation and phonological disorders
Organic (known physical cause) - e.g., cleft lip/palate, cerebral palsy
Functional (no known physical cause)
Unknown etiology
What do we want from a comprehensive assessment?
Case History
Hearing Screening
Oral facial sensory motor exam
Formal assessment
Expressive and receptive formal assessments
Informal assessment
Cognitive assessment
Piaget’s stages of cognitive development
Effective communicator profiles
Language assessment
Will depend based on communication level
Speech and language sampling
Analyze sample
Calculate mean length of utterance (MLU)
Calculate rate of speech (count # of words per minute)
Communication level
Prelingual/Nonverbal
Expressive language:
Receptive language:
Single-word user
Expressive langauge:
Receptive language:
Multi-word user
Expressive langauge:
Receptive language:
Formal Analysis for FLUENCY
Severity Scale - assess degree of impairment
Covert Scale - assess degree of emotional component
The Overall Assessment of the Speaker’s Experience of Stuttering (OASES)
Test of Childhood Stuttering (TOCS)
Informal Assessment for FLUENCY
Determining the development of typical dysfluencies vs. a fluency disorder
Stuttering
irregular repetitions, prolongations, blocks that include secondary behaviors
person is usually aware of their dysfluency
Cluttering
rapid/irregular rate of speech, abnormal disfluencies, reduced intelligibility
individual is usually UNAWARE
Assessment of a YOUNG CHILD (2-6 yrs./o.)
Purpose → to determine if the child will need speech-language tx.
identify normal vs. abnormal fluencies
identify likelihood of recovery without therapy
Comprehensive Assessment
case history, speech sample, observation, and other speech-language comorbidities
speech and language sample:
type/frequency of disfluencies
duration of disfluencies
rhythm and rate of speech
secondary behaviors
parent interactions and reactions
awareness to stuttering/disfluencies
Assessment of an OLDER CHILD/ADULTS (7+ yrs./o.)
Purpose → to gather comprehensive information (i.e., nature/impact) of the disorder
identify readiness
identify desire for therapy
Comprehensive Assessment
case history, speech sample, observation, and other speech-language comorbidities
speech and language sample:
type/frequency of disfluencies
duration of disfluencies
rhythm and rate of speech
over features (core vs. secondary)
core behaviors (involuntary)
secondary behaviors (voluntary → but then turns into learned behaviors)
Informal Assessment
Determine etiology
Team approach (refer to ENT for structure and SLP treats function)
Organic: problem w/ structure (e.g., cancer)
Neurogenic: innervation to structure impaired/damaged (e.g., VF paralysis)
Functional: non biological; behavioral/psychogenic (e.g., muscle tension)
Analyze conversation
Characteristics based on acoustic and perceptual factors
pitch, loudness, quality
Pitch
Acoustic evaluation
determine pitch
fundamental frequency
Perceptual evaluation
mono pitch, restricted range
excessive pitch variability
diplophonia, pitch breaks
Loudness
Acoustic evaluation - measure intensity level
Perceptual evaluation
lack of voice; range of loudness
inappropriate (soft/loud/monotone)
phonation breaks
Quality
Acoustic evaluation
jitter (frequency)
shimmer (amplitude)
s/z ratio
Perceptual evaluation
breathy
Resonance
Hypernasal - too much air going through nasal cavity
Nasal emission - look for pressure consonants
Hyponasal - not enough air going through nasal (i.e., sounds like a cold)
Respiration
type of breathing patterns → diaphragmatic, clavicular
stridor: VF paralysis may be present
number of words per minute (6 or less may indicate a problem)
maximum phonation time: sustained vowel
rate: words per minute, perceptual judgement of rate