Ch 11 Flashcards
Evaluation of resonance and velopharyngeal function begins with a __________ _______ _____________.
Evaluation of resonance and velopharyngeal function begins with a perceptual speech assessment.
Goals of a speech and resonance assessment:
- To determine whether a ________/_______ disorder exists and, if so, the ______, ______, and possible _______
- To obtain enough _______ in order to make appropriate _____ for _______
- To determine whether a speech/resonance disorder exists and, if so, the type, severity, and possible cause
- To obtain enough information in order to make appropriate recommendations for treatment
In the first year, speech pathologists should focus on:
- ____________
- ____________ __________
- ____________ of the ________ for _________
- ____________ __________ regarding _____/__________ ____________
Feeding
Language development
Development of the prerequisites for speech
Counseling parents regarding speech/language stimulation
A ______ evaluation of _____/______ skills should be done in early years:
- At least _____ during first ____ years
- At least ______ until age ___
A screening evaluation of speech/language skills should be done in early years:
- At least twice during first two years
- At least annually until age 6
A _______ evaluation of _____ and _____ should be done around age ___; a _____ evaluation should be done if _____ are suspected through _____ or _____ report.
A comprehensive evaluation of speech and resonance should be done around age 3; a language evaluation should be done if problems are suspected through screening or parent report.
A _____ and ______ evaluation should be done before any _____ for _____.
A speech and resonance evaluation should be done before any surgery for VPI.
Interview: Rule of thumb: If the _____ is worried about _____, there is probably a _____ reason for it.
Rule of thumb: If the caregiver is worried about speech, there is probably a valid reason for it.
Speech Samples:
_____-______ articulation test is ____ ______.
We don’t talk in _____ words.
____ _____ place _____ demands on the _____-_____ system.
_____ phoneme may be affected by _____ _____.
This kind of test is ______-______.
Single-word articulation test is not advised.
We don’t talk in single words.
Single words place limited demands on the oral-motor system.
Target phoneme may be affected by phonemic context.
This kind of test is time-consuming.
Speech Samples:
Repetition of ____ and _____ is easier, ____ and provides more _____.
Repetition of syllables and sentences is easier, faster and provides more information.
Speech Samples:
For ______ and nasal _____, _____ sounds also provide information
For resonance and nasal emission, isolated sounds also provide information
Speech Samples for Informal Assessment:
- ______ of sounds
- ______ of ________
- __________ of _______ with ______-________ ___________
- ________
- _________ _______
Prolongation of sounds Repetition of syllables Repetition of sentences with pressure-sensitive consonants Counting Connected speech
Single Sounds:
To test for hypernasality:
_______, particularly ____ vowel /___/ and ____ vowel /___/
To test for hypernasality:
Vowels, particularly low vowel /ɑ/ and high vowel /i/
Single Sounds:
To test for nasal emission:
_____ /____/
To test for nasal emission:
Prolonged /s/
Single Sounds:
To test for hyponasality or cul-de-sac resonance:
_____ /____/
To test for hyponasality or cul-de-sac resonance:
Prolonged /m/
Syllable Repetition: To test hypernasality and/or nasal emission (and to test articulation), use \_\_\_\_\_ \_\_\_\_\_\_ with \_\_\_\_ and \_\_\_\_ \_\_\_\_\_\_: pɑ, pɑ, pɑ, pɑ, … tɑ, tɑ, tɑ, tɑ, … kɑ, kɑ, kɑ, kɑ, … sɑ, sɑ, sɑ, sɑ, … ʃɑ, ʃɑ, ʃɑ, ʃɑ, … etc. pi, pi, pi, pi,… ti, ti, ti, ti,… ki, ki, ki, ki,… si, si, si, si,… ʃi, ʃi, ʃi, ʃi, … etc.
To test hypernasality and/or nasal emission (and to test articulation), use oral consonants with high and low vowels: pɑ, pɑ, pɑ, pɑ, … tɑ, tɑ, tɑ, tɑ, … kɑ, kɑ, kɑ, kɑ, … sɑ, sɑ, sɑ, sɑ, … ʃɑ, ʃɑ, ʃɑ, ʃɑ, … etc. pi, pi, pi, pi,… ti, ti, ti, ti,… ki, ki, ki, ki,… si, si, si, si,… ʃi, ʃi, ʃi, ʃi, … etc.
Syllable Repetition: To test for hyponasality, use \_\_\_\_ \_\_\_\_\_ with \_\_\_\_ and \_\_\_\_ \_\_\_\_\_: mɑ, mɑ, mɑ, mɑ, … nɑ, nɑ, nɑ, nɑ, … mi, mi, mi, mi,… ni, ni, ni, ni, …
To test for hyponasality, use nasal consonants with high and low vowels: mɑ, mɑ, mɑ, mɑ, … nɑ, nɑ, nɑ, nɑ, … mi, mi, mi, mi,… ni, ni, ni, ni, …
Sentence Repetition: p/b—Popeye plays baseball. t/d—Take Teddy to town. Do it for Daddy. k/g—Kate eats the cake. Go get the wagon. f/v—Fred has five fish. Drive the van. s/z—I see the sun in the sky. /ʃ/—She went shopping. /ʧ/—I ride a choo-choo train. /ʤ/—John told a joke to Jim. /r/—Run down the road. I have a red fire truck. /l/—Look at the lady. Blends—splash, sprinkle, street
Sentence Repetition: p/b—Popeye plays baseball. t/d—Take Teddy to town. Do it for Daddy. k/g—Kate eats the cake. Go get the wagon. f/v—Fred has five fish. Drive the van. s/z—I see the sun in the sky. /ʃ/—She went shopping. /ʧ/—I ride a choo-choo train. /ʤ/—John told a joke to Jim. /r/—Run down the road. I have a red fire truck. /l/—Look at the lady. Blends—splash, sprinkle, street
Counting: To test \_\_\_\_ \_\_\_\_\_\_: Count from \_\_\_\_ to \_\_\_\_\_ Repeat \_\_\_\_ or \_\_\_\_\_ over and over 66 = /sɪksti sɪks/ Good combination of \_\_\_\_\_ and \_\_\_\_\_ in \_\_\_\_\_
To test nasal emission: Count from 60 to 70 Repeat 60 or 66 over and over 66 = /sɪksti sɪks/ Good combination of plosives and fricatives in blends
Counting:
To test ________:
Count from _____ to ______
Repeat _____ over and over
To test hyponasality:
Count from 90 to 99
Repeat 99 over and over
_______ speech increases demand on ___ ______ to achieve and _____ _______.
________ and _____ _______ is more obvious.
More _______ errors can occur.
Connected speech increases demand on VP valve to achieve and maintain closure.
Hypernasality and nasal emission is more obvious.
More articulation errors can occur.
What to evaluate: \_\_\_\_ \_\_\_\_\_\_\_ production \_\_\_\_\_\_\_\_ \_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ \_\_\_\_ \_\_\_\_\_ \_\_\_\_\_\_\_\_ \_\_\_\_-\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_
Speech sound production Stimulability Nasal emission Weak consonants Short utterance length Oral-motor dysfunction Resonance Phonation
Need to determine the presence of the following:
________ errors
________ errors
________ errors
Need to determine the presence of the following:
Placement errors
Phonological errors
Developmental errors
With structural anomalies, need to also determine presence of the following:
_________ errors
_________ errors
With structural anomalies, need to also determine presence of the following:
Obligatory errors
Compensatory errors
Obligatory errors—_______ is normal, but the ______ abnormality interferes; requires correction of ______ only
Obligatory errors—articulation is normal, but the structural abnormality interferes; requires correction of structure only
Compensatory errors—______ is altered due to _______ abnormality; requires correction of ______ and then correction of ______ through therapy
Compensatory errors—articulation is altered due to structural abnormality; requires correction of structure and then correction of function through therapy
Obligatory Errors: \_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_ of \_\_\_\_\_ phonemes (m/b, n/d, ŋ/g) \_\_\_\_\_\_ or \_\_\_\_\_\_ consonants \_\_\_\_\_\_ \_\_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_\_
Hypernasality Nasalization of oral phonemes (m/b, n/d, ŋ/g) Weak or omitted consonants Nasal emission Short utterance length
Compensatory Errors: \_\_\_\_\_\_ \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ Note: These can also be due to \_\_\_\_\_\_\_\_ in the absence of \_\_\_
Glottal stops
Pharyngeal fricatives
Pharyngeal plosives
Note: These can also be due to mislearning in the absence of VPI
- Stimulability—the ability to _____ an _____ speech sound production when given ____ _____.
- Need to determine whether change in ______ eliminates nasal emission of ______ on that sound
- Stimulability is a good _____ indicator for ______ or correction with therapy
- Stimulability—the ability to correct an abnormal speech sound production when given minimal cues
- Need to determine whether change in placement eliminates nasal emission of hypernasality on that sound
- Stimulability is a good prognostic indicator for improvement or correction with therapy
Nasal Emission:
- Need to determine the type:
- Characteristics of a ____ gap
- Characteristics of a ____ gap
- Need to determine _______
- Need to determine whether ____ _____ is ______ specific
- Need to determine the type:
- Characteristics of a large gap
- Characteristics of a small gap
- Need to determine consistency
- Need to determine whether nasal emission is phoneme specific
Nasal Emission: Large gap: Usually barely \_\_\_\_\_\_ or even \_\_\_\_\_\_\_ to naked ear Associated characteristics include: -\_\_\_\_\_ or \_\_\_\_\_\_ consonants -\_\_\_\_ \_\_\_\_\_\_ \_\_\_\_\_\_\_\_ -\_\_\_\_ \_\_\_\_\_\_\_
Large gap: Usually barely audible or even inaudible to naked ear Associated characteristics include: Weak or omitted consonants Short utterance length Nasal grimace
Nasal Emission:
Small gap:
Usually in the form of a ____ _____
Can be due to ____struct ure or can be phoneme-specific due to use of ____ or _____ articulation
Small gap:
Usually in the form of a nasal rustle
Can be due to abnormal structure or can be phoneme-specific due to use of glottal or pharyngeal articulation
- Nasal rustle can be due to abnormal ______ or abnormal ______.
- To determine cause, ______ must be tested.
Nasal rustle can be due to abnormal structure or abnormal function.
To determine cause, consistency must be tested.
Nasal Rustle Consistency: Abnormal Structure \_\_\_\_ \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ Occurs in \_\_\_\_\_\_\_-\_\_\_\_\_\_ sounds (including /\_\_, \_\_, \_\_/)
Abnormal Structure
Small gap
Inconsistent
Occurs in pressure-sensitive sounds (including /p, t, k/)
Nasal Rustle Consistency: Abnormal Function \_\_\_\_\_\_\_ \_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ Only occurs on \_\_\_\_\_ \_\_\_\_\_\_\_, particularly \_\_/\_\_
Abnormal Function
Articulation error
Consistent
Only occurs on certain phonemes, particularly s/z
Weak Consonants:
- Due to inadequate ____ air pressure
- Associated with ____ air emission and ______
- Caused by a ____ ___ opening
- Test by having the individual repeat _____ loaded with ______-_______ consonants
- Due to inadequate oral air pressure
- Associated with nasal air emission and hypernasality
- Caused by a large VP opening
- Test by having the individual repeat sentences loaded with pressure-sensitive consonants
Short-Utterance Length:
- _____ of air through the ____ causes the person to have to take more frequent ______ to replenish the airflow.
- This ______ utterance length.
- Leak of air through the nose causes the person to have to take more frequent breaths to replenish the airflow.
- This shortens utterance length.
Oral-Motor Dysfunction:
-May be more common with ______ _______ (e.g., velocardiofacial syndrome)
To test use the following:
-______ ______
-________ exercises (e.g., /pʌtʌkʌ, pʌtʌkʌ, pʌtʌkʌ, pʌtʌkʌ/)
-______ and _______ production of _______ words (e.g., “baseball bat,” “kitty cat,” “puppy dog,” etc.)
-May be more common with craniofacial syndromes (e.g., velocardiofacial syndrome)
To test use the following:
-Published tests
-Diadochokinetic exercises (e.g., /pʌtʌkʌ, pʌtʌkʌ, pʌtʌkʌ, pʌtʌkʌ/)
-Rapid and repeated production of multisyllabic words (e.g., “baseball bat,” “kitty cat,” “puppy dog,” etc.)
Resonance: Most important to determine the type: \_\_\_\_\_ \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_
Most important to determine the type: Normal resonance Hypernasality Hyponasality Cul-de-sac resonance Mixed resonance
Resonance Severity: Rating scales can be used: -\_\_\_\_\_-\_\_\_\_\_ \_\_\_\_\_\_ -\_\_\_\_\_\_\_, \_\_\_\_\_, \_\_\_\_\_\_\_, \_\_\_\_\_\_ -\_\_\_\_\_\_ or \_\_\_\_\_\_ Usually, \_\_\_\_\_ \_\_\_\_\_\_ doesn’t matter because it doesn’t affect \_\_\_\_\_\_\_ decisions.
Rating scales can be used: Seven-point scale Normal, mild, moderate, severe Present or absent Usually, severity rating doesn’t matter because it doesn’t affect treatment decisions.
Phonation: Evaluate for signs of dysphonia. \_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_ \_\_\_\_\_\_ or \_\_\_\_ \_\_\_\_\_ Judge ability to \_\_\_\_\_ phonation for \_\_\_ \_\_\_\_ or longer.
Evaluate for signs of dysphonia. Hoarseness Breathiness Low pitch or high pitch Judge ability to sustain phonation for 10 seconds or longer.
*Supplemental Eval Procedures: Use same type of speech samples: \_\_\_\_\_\_ detection: \_\_\_\_ it \_\_\_\_\_\_ detection: \_\_\_\_ it \_\_\_\_\_\_ detection: \_\_\_\_ it Note: See text for description of methods and interpretation
Use same type of speech samples: Visual detection: See it Tactile detection: Feel it Auditory detection: Hear it Note: See text for description of methods and interpretation
Visual Detection
Dental Mirror
Air Paddle
See-Scape
Tactile Detection
Feel the sides of the nose
Auditory Detection
Cul-de-sac test
Stethoscope
Listening Tube
Straw
Differential Diagnosis:
Determine whether ______ is ____ ______ (due to misarticulation) or occurs on ____ sounds
Determine whether nasality is phoneme specific (due to misarticulation) or occurs on many sounds
Differential Diagnosis:
To determine whether _____ ______ is due to ____ or a ______:
Test the difference between the /__/ sound (which is usually ___ the fistula) and /___/.
If nasal emission is ____ heard on /___/, the fistula ___ the source.
If it occurs on ____, but more on the /___/, there is ___ VPI and a symptomatic fistula.
To determine whether nasal emission is due to VPI or a fistula:
Test the difference between the /k/ sound (which is usually behind the fistula) and /t/.
If nasal emission is not heard on /k/, the fistula is the source.
If it occurs on both, but more on the /t/, there is both VPI and a symptomatic fistula.
Speech Characteristics and Size of Gap:
Largest gap=
Hypernasality, inaudible nasal emission, weak consonants, short utterance length, low volume
Speech Characteristics and Size of Gap:
Next to largest gap=
Hypernasality, audible nasal emission
Speech Characteristics and Size of Gap:
Next to smallest gap=
Nasal emission with essentially normal resonance
Speech Characteristics and Size of Gap:
Smallest gap=
Nasal rustle (turbulence) with normal resonance
