Speech And Reso Assessment Flashcards
OPM Assessment
Lips
Jaw
Teeth
Tongue
Hard palate
Soft palate
Velopharyngeal closure
Nasal cavity
What do we assess in the OPM assessment?
- Anatomy - appearance of facial bones, tissues, symmetry
- Physiology - ROM, strength, precision and motor control, speed, sensation
- Speech - Articulation, DDK
What do we generally assess during an OPM Assessment?
- Structure - appearance, tone, and size
- Mobility (range, speed, accuracy, diadochokinesis)
- Strength (resistance to pressure, endurance, steadiness)
- Motor planning (DDK, coughing, throat clear)
What do you assess with the structure: Lips
Symmetry and size
Movement: labial retraction, pursing, puckering, puff
DDK: /pa/
Speech: /p, b, m/ → bilabial sounds
OPM Assessment: Jaw
Symmetry and deviation
Movement: elevate, depress, lateralize
OPM Assessment: Tongue
Symmetry and deviation
Movement: protrusion, retraction, /lateralization → for the purpose of eating
DDK> /ta/
Speech: /t, d, n/
OPM Assessment: Hard palate
Shape and width
Presence of scarring
Relevant for CLAP patients
OPM Assessment: Soft Palate
- Velar movement when saying /a/
- Interrupted (staccato) and sustained
- DDK: kuh
- Puffing → when we puff, our velum closes so the air pressure is just accumulated in the oral cavity.
- Puffing with tongue protrusion
Normal DDK rates can assess:
It can assess the motor planning - sequencing the articulatory movements well (pa-ta-ka)
Speech sampling assesses?
Each phoneme assessed in initial, medial, and final position
Contrast with pre-, inter-, and post vocalic
What stimuli can you utilize for speech sampling?
Picture, word lists, sentences, conversation sampling
Why is speech sampling important?
Determine nature of errors (substitution, omission, distortion, or addition)
What information will you obtain from speech sampling?
- Phonetic inventory - all phonemes
Stimulability
Nature of errors: SODA? Phonological process?
What is the quantitative measure that we can get after obtaining a speech sample?
PCC
Why do we need to get the percentage of correct consonants? What are the equivalent of the percentages?
Quantifies the severity of spontaneous speech
85%-100% Mild
65%-85% Mild/Moderate
50%-65% Moderate/Severe
<50% Severe
What is the formula for the percentage of correct consonants?
of correct consonants / # total of all consonants x 100
What are the rules of PCC?
- Consider only intended (target) consonants in words. Intended vowels are not considered.
- Addition of a consonant before a vowel, for exam on [hon] is not scored because of the target sound /ɔ/ is a vowel
- Do not score target consonants in the second or successive repetitions of a syllable, for example, ba-balloon, but score only the first /b/
- Do not score consonants that are completely or partially unintelligible or where the transcriber is uncertain of the target
- Do not score target consonants in the third or successive repetitions of adjacent words unless articulation changes–word repetition
True or False. Addition of a sound to a correct or incorrect target consonants, for example, cars for [karks]. The child will have two errors.
True
How do we get the intelligibility?
of understood words divided by # of total words
What is intelligibility?
- Perceptual judgment by a listener
- % of words understood in a sample
What is stimulability? Why do we do it? If good stimulability?
- Will tell if a sound will be acquired without intervention
- If good stimulability–the child will be able to produce the sound without intervention
- Good stimulability will lead to faster progress
- More chance of learning through maturation
- Stimulable sounds to be targeted first
- MORE STIMULABILITY = BETTER PROGNOSIS
What should we look into when there are SODA errors to find a persistent pattern?
- Place, manner, voicing
Phonological process analysis
According to type of PP committed
Presence of phonological process and check if it is typical or atypical
If the child exhibits errors and through stimulability, those errors are corrected without phonological therapy, this is indicative of
Articulation disorder
Phonological vs phonetic
Phonological: This is per syllable
Phonological Awareness Assessment (How do we assess this?)
- Syllable blending - The clinician will say “cow” pause “boy”. The child will put the words together. Example: ro-pause bot. The child is expected to say: robot
- Syllable segmentation (the clinician will say the whole word (e.g., cowboy) and then the clinician will ask the student to clap (how many syllables are there in the word cowboy so the child will clap two times)
- Syllable deletion - The clinician will say “Say cupcake. Now say it again but don’t say cake”
- Syllable rhyme awareness - The clinician will ask if two words rhyme (yes or no). “Bay hay”
What is phonetic awareness?
- Non word pairs are utilized for discrimination
- Example: Duth - dus
- We are not concerned with the meaning more on sounds
What is phonemic awareness?
- Real word minimal pairs are utilized for discrimination
- Example: bike - bite
What is phoneme segmentation?
Segmenting the phoneme
Word: pig → Correct answer: (/p/ /i/ /g/)
What is phoneme deletion?
Deleting the phoneme
Example: If I said the word “fan” you would say “an”. Let’s try another one. Win. Correct answer: (in)
Phonological disorder
2 or more phonemes represented by the same production (e.g., /t/ for /s/ and /ʃ/)
Meaning di nila nadidifferentiate yung sounds
If there is preservation of phonemic contrasts. Same occurrence in prevocalic, intervocalic, and postvocalic positions. Peripheral, motor based problems–consistent, and inadequate learning is generalized
Articulation disorder
Emerging/easy contexts → Isolated production and good stimulability when provided arctic techniques without providing phonological intervention
Articulation disorder
What are syllable constraints?
- Finding shapes that are constrained
- We are looking the patterns (errors of which the child presents difficulty)
- Example: the child has difficulty with longer or with more complex syllables
Mga allowable syllable structure and hahanapin kung saan doon mas nahihirapan yung px
What do you further assess in assessment of apraxia?
- Checking for sequential, volitional movements in speech and nonspeech tasks through imitation and commands
Nonspeech tasks: Pucker your lips and puff your cheeks
You can also use standardized tests
Signals/Signs for apraxia
Variable vowel and diphthong errors indicative of apraxia
Nasality and NAE without CLAP
Prosodic problems
Single word utterances v connected speech → THE LONGER THE UTTERANCE, THE MORE ERRORS WILL HAPPEN FOR CHILD.
Groping behavior
This assessment should always be included in a resonance evaluation. The clinician’s ear is used to analyze and inspect the resonance capabilities of the child. The clinician can make inferences about the function of the VP mechanism
Perceptual assessment
Perceptual assessment of vp? What should be identified?
- VP function’s potential for change can only be assessed perceptually
- Treatment is initiated if there is an abnormality detected by perceptual assessment
- As part of the perceptual evaluation, it should be determined if erroneous speech sound production is affected by abnormal structure (obligatory errors), or function (mislearning/compensatory errors)
How do we determine whether it is an obligatory or compensatory error? How are consonants best evaluated? Vowels?
- Isolated sounds - Can be done to estimate the phonetic inventory, Vowels can be repeated in isolation, - Consonants are best evaluated when paired with a low vowel (e.g., /ba, da, ga/) → the reason for this because of the relationship of the posterior tongue, base of tongue, and the velum.
If it is isolated sounds, what should you do for assessing hypernasality? In terms of CLAP?
Hypernasality → compare a low vowel (e.g., /a/) with a high vowel (e.g., /i/ prolonged production). Perceptually judge for HPN. *Other vowels could be tested as well. *Could be aided by touching the nasal area during production.
Vowel errors = indication of obligatory errors for CLAP
For isolated sounds, what else should you assess to identify NAE? Can be aided with?
Nasal air emission → elicit a prolonged production of a pressure sensitive, consonant (e.g., /s/)
NAE: You do not test for vowels, you only test for high-pressured sounds (e.g., plosives, fricatives, affricates)
Perceptually judge NAE → if air is coming out of the nose
You don’t use or add vowels. You simple use /p/ not /pa/–NAE
Could be aided by instruments like mirror, air paddle, etc.,
To test for other errors for isolated sounds, what else can you assess?
Pair target consonants with a vowel sound (e.g., /k/ → /ka/)
Low vowels are a priority but high vowels could be paired as well
Judge the consonant for obligatory/compensatory errors
Syllable repetition
-Which vowels should be used?
- Which cognates? Why?
- One vowel and one consonant paired
- High vowel and a low vowel in separate instances for comparison
- Eliminates the potential effects of other sounds
- Syllables in a repetitive manner (e.g., papapapa, pepepe, pipipipi)
- Voiceless cognates first to detect hypernasality and nae → voiceless cognates require more air pressure to be built up and released during their production compared to their voiced cognates.
Procedure:
High pressure consonant (preferably its voiceless cognate, e.g., /p/ > /b/)
Pair with low vowel (e.g., pa)
Repetitive production (e.g., papapapa)
Pair with a high vowel (e.g., /pi/)
Judge for hypernasality, NAE, and differences in vowel pairing
Use instruments as aid if needed
Why do we test the word level? What is a sample procedure of it?
- Use to test the ability to produce the sound in the context of other sounds
- Testing the capability of producing the sound in different word positions
- Prevocalic, intervocalic, postvocalic/IMF
Procedure:
- Select a sound to be tested (e.g., /b/)
- Prepare words within the IMF positions (try to limit the words to 1-2 syllables)
- Bola, labo, Taob
- Perceptually judge for HPN, NAE, in the different word positions
Why do we test sounds in connected speech?
What should the sentences be?
What sounds should be used to assess the following?
- NAE
- Hyponasality
- Hypernasality
- Producing sounds with coarticulatory factors
- Each sentence should be loaded with phonemes in a similar articulatory placement to assess a specific characteristic
- Pressure sensitivity continuants for NAE
- Low, voiced, oral sounds for perceptual speech hypernasality
- Nasal sounds for hyponasality
Counting
60’s series (/s, k/) - NAE
70’s series - differential diagnosis
80’s series - perceptual hypernasality
90’s series - Hyponasality
Differential diagnosis. You will determine if errors are due to:
- Typical development
- Phonological issues
- Structural issues - obligatory errors
- Apraxia
- Cleft related structural issue
- Compensation
In essence, be criticsl, alamin yung pinaka cause ng errors
NAE Assessment:
Which sounds should be tested?
Low vs High Intensity?
Look for occurrence of what?
If NAE is in all sounds?
If NAE is specific sounds?
- All pressure sensitive phonemes must be tested
- Low intensity (inaudible) - larger opening
- High intensity (audible) - smaller opening
+/- occurrence of nasal grimacing - NAE is consistent across all pressure sensitive sounds → velopharyngeal dysfunction
- NAE occurs only on select pressure sensitive sounds (usually /s/ o /sh/) → faulty articulation/mislearning
What type of errors are the following?
- weak consonants
- short utterance length
What do they denote?
How can we assess short utterance length?
Obligatory errors
- Weak consonants → denotes the inadequacy of intraoral pressure in production,
- Short utterance length → consistent air leakage could lead to a diminished airflow → counting from 1-20 using one breath (note: most normal speakers could count to at least 15)
Visual detection - mirror test
- Only for NAE
- You cannot use this for hypernasality
- Procedure: placing a dental mirror directly below the nares. If the mirror clouds up → NAE
Error prone because placing the mirror before or after the child begins to speak Normal respiration will cause the mirror to cloud regardless of NAE
Visual detection - air paddle
- Same procedure as mirror test
- Ideally only used for voiceless, pressure consonants
- Only for NAE
- Not very sensitive and could only work if NAE is severe
- It is a piece of paper
Tactile detection
- Placing the fingers on the nasal area during production
- Vibration during the production of oral sounds → hypernasality
- No use for NAE assessment
Auditory Detection - Nasal Cul De Sac Test
What sounds should be use for NAE? Hypernasality?
- Produces a sound with an unoccluded nose
- Produce the same sound again with an occluded nose
- Can use for NAE - pressure sensitive sounds (e.g., p, t, k)
- Can use for HPN - vowels only - No change - normal VP movement
Auditory detection - listening tube/stet/onl
- End of tube under nose for NAE
- Drum of stethoscope or funnel of an ONL (oronasal listener) on the nasal area for hypernasality
- Can be used as an auditory feedback tool for intervention purposes
Auditory detection - straw
Can also be used for?
- Differential diagnosis - HPN and NAE
- Place the short end of the straw directly below the child’s nose - If there is audible airflow - NAE
- No audible airflow - HPN
- Can also be used for lateral lisps
What are the two categories under Instrumental Assessment?
- Direct - provides a view of the velopharyngeal area
- Indirect - does not provide a view of the velopharyngeal area
Multi view: Videofluoroscopy
- Dynamic, real time view of the VP
- No score required
- Transnasal barium
Provides a direct view of VP, + Velar and pharyngeal wall movement. Used more than the videofluoroscopy.
Endoscopy
This is an indirect instrumental assessment , it is quantitative and noninvasive. What does it use to assess nasal acoustic energy?
- Nasometry
- It uses a computer to assess nasal acoustic energy
Aerodynamic pressure flow
- Measures clinical properties of airflow
- Quantitative data regarding VPD.
