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Speech Sound Disorders in Selected Populations

Overview of selected populations who have speech sound problems as one of their main difficulties

Childhood Apraxia of Speech

  • Neurological childhood speech sound disorder where precision and consistent of movements underlying speech are impaired without neuromuscular deficits

    • lack sequential volitional control of the oral mechanism​

    • difficulty planning/programming resulting in speech sound errors and prosodic errors

    • groping behavior: ongoing series of movements of articulators to find the appropriate position

    • silent posturing: positioning the articulators without sound production

  • Occurs in three contexts:

    • known neurological etiologies​

      • intrauterine stroke​

      • infections

      • trauma

    • as a result of complex neurobehavioral disorders

      • genetic​

      • metabolic

    • as an idiopathic neurogenic disorder with no known neurological or complex behavioral disorders

  • Have higher rates of family history than other speech sound disorders

  • Therapy

    • high amount of intense, individual therapy​

    • progresses systematically through hierarchies of task difficulties

    • careful incremental increases of sequential movements

    • drill oriented sessions

    • emphasize self-monitoring

    • possibly do auditory discrimination tasks

    • use multiple modalities

    • intensive word on prosodic features

    • possibly use compensatory strategies

    • provide successful experiences

Motor-Speech Disorders: Cerebral Palsy

  • Cerebral palsy (CP) is a non-progressive disorder of motor control caused by damage to the developing brain during the prenatal, perinatal, or early postnatal period

  • Lack volitional speech-motor control

  • Respiratory, phonatory, resonatory, articulatory, prosodic and velopharyngeal inadequacies

  • Three types: spasticity, diskinesia, and ataxia

  • Therapy

    • some prerequisites for speech must be met​

    • head control

    • coordination of respiratory patterns with voice and articulatory efforts

    • inhibit abnormal oral reflexes 

    • speech and language stimulation essential, beginning with vocal play and babbling practice in infants

    • for older children, begin with reflex-inhibiting postures

    • then temporal coordination and motor control of speech muscles

    • increase speed, range, and accuracy of movements

    • select targets based on stimulability, consistency, and visibility

    • can treat groups of sounds​

      • train consonants articulated correctly first in prevocalic, then postvocalic positions​

      • distortions treated before substitutions and omissions

      • auditory and visual stimulation

      • strive for reasonable compensations if not able to achieve norm productions

Cleft Palate

  • Division of the continuous structure by a split often caused by failure of the palate to fuse during fetal development 

  • Developmental speech-language delays are more common in children with cleft palates

  • Children with cleft palates are also more prone to intermittent middle eat infections

  • Velopharyngeal port incompetency (VPI) 

    • hypernasal resonance​

    • nasal air emissions

    • sound distortions​

    • sound substitutions

      • often backing​

    • problems primarily with stops, sibilants, fricatives, and affricates

      • due to VPI impairing intraoral pressure buildup​

  • Therapy

    • improve place of consonant production, more forward​

    • improve velopharyngeal valve function

    • decrease hypernasal quality

    • modify compensatory articulations

    • improve phonological system if developmental phonological errors

Intellectual Disability

  • Three criteria: limitations in adaptive skills, subaverage intellectual functioning, and manifestation of a cognitive impairment before 18 years of age

  • 40 times more likely to have a hearing impairment

  • 70% have speech production difficulties

  • Phonological characteristics

    • deletion of consonants (most frequent error)​

    • inconsistency of error productions

    • some errors similar to functional delay

  • Down Syndrome

    • extra copy of chromosome 21 

    • usually have a mild to moderate cognitive impairment​

  • Therapy

    • use over learning and repetition​

    • in natural environment

    • begin as early as possible

    • follow developmental guidelines

    • overall intelligibility rather than individual sounds

    • enlist caregivers

    • serve the daily routine

    • short, repetitive, reinforced, meaningful activities

Hearing Impairment

  • Any diminished ability in normal sound reception

  • Errors

    • consonant and vowels​

    • stress, pitch, and voicing

    • consonant deletions, especially final consonants

    • substitutions

      • confusion between voiced and voiceless cognates​

      • stopping of fricatives and liquids

      • confusion between oral and nasal consonants

      • neutralize vowels

      • tense/lax vowel substitutions

    • prosodic feature realization also may be affected

  • Therapy

    • usually directed towards improving client's intelligibility

    • speech signal amplification​

    • systematic auditory training for speech perception

    • auditory-verbal therapy

Motor-Speech Disorders in Adults

  • Apraxia of speech

    • disorder of expressive communication resulting from brain damage that affects the normal realization of speech sounds, sound sequences, and prosodic features​

    • absence of muscular weakness

    • inconsistent articulatory errors

    • articulation primarily affected

    • therapy

      • all stimuli should be meaningful​

      • articulatory accuracy

      • no nonsense syllables

      • short words

        • errors increase with length​

      • simple sounds

        • sibilants, affricates, and clusters increase error rate​

  • The dysarthrias

    • neuromuscular speech disorders​

    • many different causes

    • types: spastic, ataxic, hypokinetic, hyperkinetic, flaccid, and mixed

    • all processes of speech affected: respiration, phonation, resonation, and articulation

    • predictable, consistent articulatory errors

    • therapy

      • help become production patient​

      • modify abnormalities of posture, tone, and strength

      • modify respiration, phonation, resonation, articulation, and prosody

      • provide alternative or augmentative modes of communication if needed

Bauman-Wängler, J. A. (2020). Articulation and phonology in speech sound disorders: a clinical focus (6th ed.). Hoboken: Pearson Education.

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