Assessment of Organic and Neurogenic Speech Sound Disorders Flashcards
How to identify Speech Sound
Disorders
And type of Disorders
To identify SSD associated with structural, sensory,
or neurological clinical conditions.
Assessment goals and procedures for the following
disorders:
Childhood Apraxia of Speech
Developmental Dysarthria in Cerebral Palsy
Cleft Lip and Palate
Hearing Impairment
Childhood Apraxia of Speech
Childhood apraxia of speech (CAS) is a neurological
childhood speech sound disorder in which the precision and
consistency of movements underlying speech are impaired in
the absence of neuromuscular deficits (e.g. abnormal reflexes,
abnormal tone)”.
The core impairment in planning and/or programming
spatiotemporal parameters of movement sequences results in
errors in speech sound production and prosody (ASHA, 2007a,
Definitions of CAS section, para. 1).
Oral apraxia
Oral apraxia - difficulty with volitional control of
nonspeech movement (e.g. difficulty sticking out and
wagging their tongue, or difficulty sequencing movements
for the command, “Show me how you kiss, now smile, now
blow”.
Speech apraxia
Speech apraxia - difficulty with volitional movement for the
production of speech. This can be at the level of sounds,
syllables, words, or even phrases (connected speech). The
motor struggle is most typically seen with sound sequencing.
CAS may occur due to:
CAS may occur due to:
known neurological impairment (TBI, intrauterine stroke)
complex neuro-behavioral disorder of known and
unknown origin (autism, DS)
idiopathic neurogenic speech sound disorder.
Segmental features of CAS:
Segmental features of CAS:
Poor speech intelligibility in connected speech, varies
depending on length and complexity of utterances
Inconsistency of sound errors (consonants and vowels) in
repeated productions of syllables and words
Atypical articulation errors (prolongation, addition,
nonphonemic sound production (e.g. bilabial fricatives)
Description CAS continues (Segmental):
Type of articulate groping
Description CAS continues (Segmental):
Sound and syllable sequencing difficulties: difficulty sequencing sounds in syllables and words of different length and
complexity, and on diadochokinetic speech tasks.
Articulatory groping and silent posturing
- silent posturing errors (static articulatory gesture without
audible sound)
- articulatory groping errors (a series of articulatory movements in
an effort to find the right position for a specific sound )
Suprasegmental features of CAS
and
Associated problems:
Type of prosody problems
Suprasegmental features of CAS:
Resonance issues: poor motor control of the velopharyngeal
mechanism may result in hypo/hypernasality
Prosody problems: aprosody (monotone); dysprosody
(inappropriate variation in frequency and duration);
inappropriate stress patterns (errors on syllabic stress)
Associated problems: slow progress in therapy; fine/gross
motor coordination difficulties; decreased oral awareness;
presence of oral apraxia; expressive language problems, learning
disabilities, family hx
The CAS symptoms described above may vary and should be
used with caution
The 6 characteristics
The CAS symptoms described above may vary and should be
used with caution
A survey of 75 SLPs working with CAS identified six CAS
characteristics commonly agreed upon (Forrest, 2003):
1. Inconsistent speech sound productions
2. OM problems
3. Articulatory groping
4. Difficulty imitating modeled sound productions
5. Increased problems with increased utterance length
6. Difficulty sequencing sounds
Assessment goals for CAS
Assessment of artic/phon. skills across varied tasks and situations
Assess other communication skills: Auditory compreh/verbal
expression/reading/writing/Resonance/prosody/fluency
Assess OM skills during speech and non-speech tasks
Estimate severity
Differential diagnosis
Identify potential treatment targets
Prognosis
Identify child’s strengths and intact skills (to facilitate treatment)
Assessment techniques for CAS
Developmental hx (identify problems in sucking, delays in
language development)
Assess nonimitative (use of GFTA) and imitative speech
production skills (model sounds/words/sentences and ask to
imitate, first without visual cues)
Assess consistency and variability of errors (in informal
tasks/formal tests, in varied phonetic contexts). Assess productions of the same phoneme in the same words in multiple trials.
Assess diadochokinetic syllable rate
Assess intelligibility, resonance, prosodic problems, fluency
Formal tests used:
Apraxia profile (AP; Hickman, 2000) - and the Preschool Profile and
the School-Age Profile
the Kaufman Speech Praxis Test for Children (KSPT; Kaufman,
1995); Ages: 2;0 – 5;11
Screening Test for Developmental Apraxia of Speech-2 (Blakely,
2001); Ages: 4;0 – 7;0.
Verbal Motor Production Assessment for Children (Hayden &
Square, 1999); Ages: 3;0 – 12; 11
Cerebral Palsy
Cerebral Palsy – neuromotor disorder (non-progressive), as a result
of brain damage that can be:
Prenatal (HIV; exposure to radiation , drugs, or metal toxicity, fetal anoxia,
cerebral hemorrhage, chromosomal abnormalities etc.)
Perinatal (brain trauma, cerebral hemorrhage, anoxia during birth etc.)
Postnatal (premature birth; sepsis, encephalitis/meningitis; head trauma etc.)
Different types of Cerebral Palsy:
Spastic: most common type; increased muscle tone, slow effortful/jerky
movements; pyramidal lesion.
Dyskinetic: abnormal patterns of posture/movement (involuntary,
uncontrolled, and recurring movements of the body); extrapyramidal lesion.
Ataxic: damage to the cerebellum ; affects equilibrium – issues with balance
and posture, rhythm, accuracy of movement of the body.
Mixed
Different types of Cerebral Palsy
Spastic: most common type; increased muscle tone, slow effortful/jerky
movements; pyramidal lesion.
Dyskinetic: abnormal patterns of posture/movement (involuntary,
uncontrolled, and recurring movements of the body); extrapyramidal lesion.
Ataxic: damage to the cerebellum ; affects equilibrium – issues with balance
and posture, rhythm, accuracy of movement of the body.
Mixed
Developmental Dysarthria
motor speech sound disorder associated with CP.
Dysarthria subtypes identified
5 aspects of speech that are affected
4 types of dysarthria
Cerebral Palsy may affect various parameters of speech production (respiration,
Phonation, Resonance, Articulation, Prosody)
Dysarthria subtypes identified:
Flaccid (lower motor neurons in brain stem/spinal cord and cranial/spinal
nerves to muscle fibers affected)
Spastic (CNS; upper motor neurons and tracts to brainstem/spinal cord
damaged)
Ataxic (cerebellar system damaged; movement incoordination)
Dyskinetic/Hyperkinetic (CNS; basal ganglia damaged)
Mixed
Description of Dysarthria
Articulatory difficulties:
Imprecise articulation (due to poor muscle strength, tone, speed,
range of motion),
Slurred speech (especially ataxic)
Slow rate of speech movements and speaking rate
Difficulty with phonation (prolonging sounds)
More omissions than substitutions or distortions, especially on final
sounds
Production in connected speech is worse than in single words
Predominance of cluster reduction, stopping, depalatalization,
fronting, gliding
Description of Dysarthria
Phonatory problems
Resonance problems
Resonance problems
Hypernasality and nasal emissions
Poor oral resonance (diff. controlling intraoral breath pressure)
Phonatory problems
Weak voice, loss of voice at the end of phrase (leads to whisper)
Poor volume and control of volume
High pitch or strained vocal quality (hyperadduction of VFs)
Breathiness (due to hypoadduction of VFs)
Description of Dysarthria (continues)
Respiratory problems
Prosodic problems
Associated problems
Description of Dysarthria (continues)
Respiratory problems
Reduced activity of the chest and neck muscles, rapid breathing rate
Indented sternum (sucked-in)
Inadequate use of air (air wastage) during speech (leads to final cons.
omissions, short phrases)
Prosodic problems
Monotone
Lack of variation in intensity
Associated problems
Slow/jerky jaw movements
Poor coordination of the tongue movements during speech
Slow diadochokinetic syllable rates
Hearing loss, MR, ADD, language disorder, learning disability
Assessment Goals: for dysarthria
Assessment Goals:
Collaborate with assessment team: doctors, nurses,
psychologists, audiologists, educators, social workers, OT, PT
Assess physiological structures during OM examination (head
control, neck stability, coordination of respiration and
phonation)
Assess communication deficits relevant to CP
Assess child’s strengths and intact skills
Follow up assessments
Assess the need/ability for use of alternative/augmentative
communication system
Assessment procedures: for dysarthria
Assessment procedures:
Observe/obtain information on:
neuromotor functions (request doctor’s reports and consult with other
specialists)
Speech and Motor development
Cognitive development
Assess OM mechanism and Feeding
Presence of structural deviations
muscle tone, breathing patterns
Sucking, chewing, biting, swallowing
Consider oral structural deviations (tongue weakness, asymmetries,
palate, jaw, malocclusions )
Speech and language sample (if verbal)
Analyze speech intelligibility and articulation errors/phon. pattern errors
Formal tests
Assessment (continues) dysarthria
Assessment (continues)
Assess prosodic patterns
Clinical judgement : Stress patterns, intonation, rate of speech, pauses
Assess voice and respiratory function
Clinical judgement re: vocal loudness/pitch (variation: jerky vs smooth)
Vocal quality (harsh, hoarse, breathy, strained, strangled)
Difficulty in voicing related to hyper/hypo- adduction of VFs
Adequacy of breath support
Assess resonance problems
Hyper/hyponasality, nasal emissions, reduced oral resonance
Obtain information on velopharyngeal functioning
Assess the need for augmentative communication
Assess oral communication abilities; OT and PT should be involved to
determine possibility of augmentative communication system use
Cleft Lip and Palate
Cleft Lip and Palate
Definition: A Cleft is a congenital anomaly, a structural
malformation, that may ‘affect the tissue/ muscles/ bony processes
of the upper lip, alveolar process, hard palate, soft palate, and
uvula” (Pena-Brooks & Hedge, 2015. p. 321).
Occurs during embryonic development: the fusion and growth
of palate and/or lips is disrupted.
Etiology: may be due to genetic syndromes (Apert, Pierre
Robin, Woude etc.), and environmental toxins (excessive
alcohol consumption, illegal and prescription drug use).
Cleft lip can be unilateral or bilateral
Cleft palate involves hard (anterior 2/3 of roof of mouth, bony
foundation and muscular overlay) and soft palate (1/3, muscle
and mucosa).
Cleft Lip and Palate
Speech sound disorders
Cleft Lip and Palate
Speech sound disorders
More difficulty with voiced sounds
Difficulty with sounds requiring build up of intraoral pressure
(weak production of fricatives, affricates, stops)
Nasals sounds substituted for non-nasal sounds
Nasal emissions for voiceless sounds
Distortion of vowels
Compensatory errors (sound substitutions to account for
inadequate closure of velopharyngeal mechanism; tongue is
moved back to stop the air )
Reduced speech intelligibility
Cleft Lip and Palate
Phonatory disorders
Resonance disorders
Associated problems:
Cleft Lip and Palate
Phonatory disorders
Hyperfunction of the voice (due to velopharyngeal inadequacy)
Vocal nodules, edema of VFs
Hoarse voice, reduced vocal intensity, Monotone voice
Strangled vocal quality: too much tension to avoid hypernasality
Resonance disorders
Hypernasality on vowels and voiced oral consonants
Hyponasality/Denasality (near absence of nasal resonance on
nasal sounds)
Associated problems:
Velopharyngeal incompetence, hx of recurrent ME infections
and HL, language disorders
Cleft Lip and Palate
Assessment procedures:
Cleft Lip and Palate
Assessment procedures:
Collect a comprehensive case history
Assess hearing function
Assess oral-motor mechanism (pay attention to unrepaired clefts)
Assess resonance (nasal flow is assessed by placing mirror under
the nares as the child prolongs /i/ - mirror should remain clear
unless child is hypernasal).
Assess connected speech production (speech sample)
Assess articulation and phonological skills using formal tests
Assess phonatory problems, based on clinical judgement (vocal
quality, abusive behaviors)
Assess velopharyngeal mechanism (sustained phonation of “ah”
allows to look at the movement of soft palate and assess
symmetry, tone, range, speed).
Hearing impairment
Hearing loss types
Range of normal hearing:
Hearing impairment
1. Range of normal hearing: child – 0-15dB; adult – 0-25dB
Hard of hearing: (less than 90dBHL) – have some residual hearing, can be
maximized through amplification devices (hearing aid)
Deaf: profound HL of at least 90dB HL.
- Hearing loss types ( mild to profound):
Conductive HL – interrupted transmission of sound to the cochlea (outer or
middle ear pathology).
Common cause of conductive HL: Otitis media (inflammation of ME),
other causes see in textbook (p. 327)
Sensorineural HL - hair cells of the cochlea (sensory loss) or fibers of the
acoustic nerve (peripheral neural loss) are damaged.
Permanent HL
Mixed HL
Communication difficulties associated with
a hearing loss:
1. Articulation problems:
2. Voice and resonance problems
3. Fluency and prosodic disturbances
Communication difficulties associated with
a hearing loss:
1. Articulation problems:
a. Omission of I and F consonants and consonant clusters, omission of /s/ across word
positions
b. Prevalence of voiced consonants in place of voiceless, nasal for oral consonants
c. Distortion of stops and fricatives sounds
d. Vowel substitutions, increased duration of vowels, breathiness
e. Addition of vowels
f. Inappropriate release of final stops
- Voice and resonance problems
a. High-pitched voice, harshness , hoarseness
b. Nasal emissions , hypernasality, lack of normal intonation - Fluency and prosodic disturbances
a. Slow rate of speech, abnormal flow and rhythm, increased rate of dysfluencies
