Chapter 21 Flashcards
Chapter 21Speech Therapy
Important**
Speech Therapy
Individuals with clefts or craniofacial anomalies are at risk for ___________ secondary to velopharyngeal insufficiency or incompetence (VPI), oral anomalies, and dental malocclusion.
Speech therapy will not correct…
Speech therapy WILL correct …
speech and resonance disorders
VPI or other structural disorders.
abnormal function (speech sound placement) that may result from these disorders.
Obligatory Distortions
Obligatory distortions—
_______is not indicated for obligatory distortions.
Obligatory distortions can only be eliminated by…
occur when function (i.e., articulation) is normal, but structure is abnormal
Speech therapy
correcting structure (i.e., through surgery or prosthetic management).
Compensatory Errors
Compensatory errors—
Common compensatory productions for VPI include
1.
2.
3.
Compensatory productions can be corrected with…
occur when articulation placement (function) is altered due to abnormal structure
1.pharyngeal fricatives, 2.pharyngeal plosives, and 3.glottal stops (most common)
speech therapy, preferably after correction of structure.
Speech Therapy with an Oronasal Fistula
Compensatory productions due to a symptomatic fistula …
A ______can be used until the fistula is surgically closed.
cannot be easily corrected with speech therapy until the fistula is closed.
palatal obturator
Speech Therapy before VPI Surgery
Speech therapy can be done while _________. However, placement is VERY hard to achieve without _______. Therefore…
1.
2.
waiting for surgery or a prosthesis; oral air flow
Nose plugging should be used to give the child increased oral air flow to convert to air pressure through articulation.
Child should wear nose plug at home as much as possible, not just during practice.
Speech Therapy after VPI Surgery
Changing structure ….
Speech therapy is appropriate for…
_______ and ______,can be effective in getting the new structures to function normally (e.g., to increase lateral wall movement around a new pharyngeal flap).
does not change function.
correction of compensatory errors after surgery.
Speech therapy, using auditory feedback
Speech for Velopharyngeal Mislearning
Velopharyngeal mislearning—
Speech therapy is effective in…
a cause of misarticulations that cause nasal emission and sometimes hypernasality, despite normal velopharyngeal structure and physiology
normalizing placement and thus, eliminating phoneme-specific nasal emission or phoneme-specific hypernasality.
When in Doubt
When in doubt about the need for surgical correction, it is always best to…
It usually only takes…
If nasality is noted with normal articulation….
do a short trial period of speech therapy.
a few weeks to determine whether therapy will be effective
surgical intervention will likely be needed.
General Principles of Speech Therapy***
Select sounds in which the child is stimulable.
Select sounds that will have the biggest impact on intelligibility.
Select anterior sounds before posterior sounds (except with /r/).
Select continuant cognate before a movement sounds (e.g., /n/ before /d/).
Select the voiceless sound before the voiced cognate.
General Principles of Speech Therapy***
Be sure the child can discriminate between the correct versus incorrect sound.
Establish placement of production before the manner.
Work on continuants and voiceless phonemes first without the vowel.
Work on voiced plosives in syllables with the vowel.
Begin with the sound in the initial position.
Use /h/ to transition consonant to the vowel.
General Principles of Speech Therapy
Once placement is obtained, work on _______
Determine whether _____________
For medial position, ________
The ________of a medial sound can change its production.
Example: In American English, the /t/ in words that end with /n/ (e.g., “kitten,” “button,” “mitten,” etc.) is usually not aspirated but instead is co-articulated with a glottal stop)
sound in initial position.
the medial or final position is easiest.
break the word up into syllables.
phonemic context
General Principles of Speech Therapy
When working on final position, _______.
When working on final word position, …
Work on sounds in _______.
When moving to the next sound in a category, __________
break up the word
combine word with a word that starts with a vowel (e.g., bake it).
categories
change one feature at a time.(so either change the placement or the manner, not both)
General Principles of Speech Therapy
Divide the consonant blends into __________.
When /s/ is combined with a typically voiceless consonant, the voiceless consonant becomes voiced (e.g., “spell” becomes “sss … bell”).
Work on the sound in _____
Work on the sound in ______
individual components
carrier phrases.
novel sentences.
General Principles of Speech Therapy
Obtain as many …
Work on carryover _____
Involve the _____and ______.
There should be ______________ each day whenever possible.
correct productions of the sound in the session as possible. ***
using unstructured speech.
parents and caregiver
several short (a few minutes at a time)practice sessions
Biofeedback
Biofeedback—
Biofeedback can be _______
Biofeedback can be ….
a technique for making unconscious or autonomic physiological processes perceptible to the senses in order to manipulate them by conscious mental control
auditory, visual or tactile-kinesthetic
low-tech or high-tech using sophisticated instrumentation
Low-Tech Therapy Tools and Techniques
Straw for feedback regarding nasal emission or hypernasality
Low-Tech Therapy Tools and Techniques
Listening tube for feedback regarding nasal emission or hypernasality
Low-Tech Therapy Tools and Techniques
Listening tube for feedback regarding oral airflow
Low-Tech Therapy Tools and Techniques
Straw for feedback regarding anterior oral airflow
Low-Tech Therapy Tools and Techniques
Straw for feedback regarding lateral emission of airflow
Low-Tech Therapy Tools and Techniques
Oral & Nasal Listener™ (ONL) to provide feedback to the child, and allow the SLP or parent to hear the same sound
Low-Tech Therapy Tools and Techniques
Oral & Nasal Listener™ (ONL) for feedback regarding nasal emission or hypernasality
Low-Tech Therapy Tools and Techniques
Oral & Nasal Listener™ (ONL) for feedback regarding oral airflow and oral sound production
High-Tech Therapy Tools
Digital recording equipment
Nasometer
Pressure-flow instrumentation
Nasopharyngoscopy
Specific Therapy Techniques***
Always use …
See text and videos for specific placement techniques for the following:
Glottal stop:
Pharyngeal plosives:
Pharyngeal or nasal fricative/affricate:
Palatal-dorsal production (middorsum palatal stop):
Nasalized (or otherwise distorted) /ɚ/ and /r/ :
Nasalized phonemes:
visual, tactile and auditory feedback to establish awareness.
Oral-Motor Exercises … They Do NOT work!
There is NO evidence to support the use _________.
There is evidence to show why they do not work.
It doesn’t make sense to use exercises for ______.
Do NOT use blowing, sucking, whistling, gagging, swallowing, cheek puffing, icing, stroking, palatal massage, electrical stimulation, playing wind instruments, etc. None of these work.
nonspeech exercises in improving velopharyngeal function
structural abnormalities
Motor Learning and Motor Memory
Speech requires motor movements that ….
This is accomplished by___________
are fast, complex, automatic, and effortless.
motor learning and motor memory.
Motor Learning
Motor learning—
Dependent on feedback through _____
Examples include learning how to: 1. 2. 3. 4.
Motor learning phase of speech therapy includes ….
acquisition of new motor skills in order to execute complex motor movements and sequences
“trial and error”
- Play a musical instrument
- Perform dance steps
- Play a sport
- Produce speech sounds in sequence for connected speech
teaching placement and providing feedback.
Motor Memory
Motor memory—
Dependent on _______ (e.g., practice)
Makes new learning _____
Motor memory phase of speech therapy requires ________ which should be done at home between sessions.
develops automaticity of the newly learned motor movement
constant repetition
relatively permanent
frequent, daily practice,
General Principles
Speech therapy is like taking piano lessons—
if you don’t practice at home, you don’t make progress!
Practice Frequency and Intensity
For best results:
Practice frequency: Frequent sessions should be done at home each day.
Practice intensity: Practice sessions can be a short (a few minutes at a time) but should include drill work for motor memory.
Ultimate Goal
1.
2.
Normal speech (without nasal emission) and normal resonance (without hypernasality or hyponasality)
Merely “improved” or “acceptable” speech is not acceptable in most cases.
Summary
Speech therapy is appropriate for:
Speech therapy is NOT appropriate for:
Obligatory errors due to abnormal structure, including hypernasality and/or nasal emission due to VPI
- Compensatory errors after correction of the structure
2. Misarticulations that cause phoneme-specific hypernasality or phoneme-specific nasal emission
