speech intelligibility

both articulation and phonological disorders affect speech intelligibility

speech intelligibility

is a judgement made by clinician based on how much of an utterance can be understood.

it's a subjective and perceptual judgement

is percentage of words understood

phonological disorders may have greater impact on intelligibility vs. pure articulation disorders as child may confuse several phonological rules.

Frontal Lisp

a lisp is a functional speech disorder(difficulty learning to make a specific speech sound, or a few specific sounds).

• the tongue protrudes betweeen front teeth
• airflow is directed forward
• ex: /s/ and /z/ soudn like "th"

typically developing children may have iterdental lisp until 41/2 yrs

• If persist SLP assessment

Lateral Lisp

NOT found in typical speech development.

• tongue position close to normal position for /l/
• airflow over the sides
• AKA "slushy ess/slushy lisp"
• sounds WET or SPITTY
• SLP assessment

some children produce sounds interdentally

tongue protrusion forward/anterior placement

[s,z,ʃ,ʒ,t͡ʃ,d͡ʒ] also[n,l]

in some everything seems INTERDENTAL, may indicated nasal obstruction due to allergy, infection, large adnoids, craniofacial anomalies, mouth breathing,tongue trust, sucking habits

CAS Childhood Apraxia

of

Speech

GENERAL FEATURES:

• known/unknown origin
• underlying neurological impairment
• higer in males
• 1-2 children per 1000
• DEVELOPMENTAL
• lacks SEQUENTIAL volitional contral of oral mechanism
• difficulty w/pusposeful voluntary movements in ABSENCE of paralysis
• AKA (DAS)developmental apraxia of speech/DVD developmental apraxia dyspraxia

Planned Movement

nuerological process by which cognition directs motor action.

ability to formulate or plan differ actions before actual motor execution

APRAXIA

LACK OF PRAXIS

lack of planned movement

ability to formulate/plan differ actions prior to actual motor execution 

MOTOR SPEECH

DISORDER

A disruption in MOTOR PLANNING

and or PROGRAMMING

execution of a motor plan is the result of praxis

PLANNING and PROGRAMMING occur prior to execution of movement.

during execution plans/programs are transformed in movements.

planning is: how the articulators transition from one POSTURE to the next.

each speech sound has a  CORE MOTOR PLAN w/number of motor GOALS.

motor goals can be found in the SPATIAL (place and manner of articulation) and TEMPORAL(timing) specifications of movements for speech sound production

(CAS) Childhood Apraxia Of Speech

• no agreement on characteristics/features to be presented for a valid CAS diagnosis
• due to features vary across children /ages and may be present w/other speech disorders.

ASHA'S definition of CAS

Childhood Apraxia of Speech

is a neurological childhodd speech sound disorder in which the percision and consistency of movements, underlying speech are impaired in teh absence of neurmuscular deficits.

CAS may occur a result of neurological impairment, in association with complex neurobehavioral disorders of known or unknown origin

as a idiopathic neurogenci speech sound disorder

impairment in planning adn /or programming spatiotemporal parameters of movement sequences results in errors in speech sound production

DIFFERENCE between AOS and CAS

Maassen 2002

In CAS a specific underlying speech motor impairment has an impact on the development of higher PHONOLOGICAL and LINGUSITIC processing levels.

CAS

Childhood Apraxia of Speech

CAS falls within the professional responsibiltiy to refer to otehr professionals: neurologist,OTs,PTs for associated nonspeech issues.

overdiagnosis: due to inconsistency/variability errors

label should be used w/caution

difficult to describe speech characteristics from developmental phonological disorders

ONSET: early and extends to adulthood

SEGMENTAL/SUPRASEGMENTAL

FEATURES associated w/CAS

• inconsistant errors on consonants and vowels in repeated productions of syllables or words(fit,vit,pit)
• Lengthened and disrupted coarticulatory transitions between sounds and syllables: slow,broken or difficult to acheive
• inappropriate PROSODY, especially on STRESS

KEY FEATURES OF

CAS in young children

• child may have no words, few words unlikely to attempt more than handful of 2 word combinations
• struggle to talk
• trial and error attempts
• frustration
• some use self taught signs/gestures
• use mime/gesture to communicate w/sound effects

CAS Speech and Non Speech

Characteristics

Speech

limited phonetic inventory

frequent/inconsistant errors on vowels/consonants

varying supra-segmental features

increase error on longer/more complex utterances

inconsistent soudn errors when same word

is repeated

unusual articulation errors

resonance problems

CAS sound and syllable

sequencing problems

difficulty sequencing the sounds in syllables or words

difficulty with multisyllabic words

DDK task is difficult/slow

increase errors with increasing lenght and complexity

CAS Non-Speech

Characterisics

silent posturing errors

groping errors

searching behaviors

slow progress

fine and gross motor incoordination

Receptive language is much better than Expressive language

word in general are not clearly spoken, exceptions such as "no"

speech errors affect VOWELS/CONSONANTS,

inconsistency is evident

sounds that are used in some words are omitted from other words

when asked to imitate speech sounds, sound effects or words, the child doesn't seem to know where to start

unusual intonation, pausing and stress patterns

may not know where to put nasal resonance

 receptive is better than expressive 

CAS Assessment Protocol

Traditional assessment includes:

case history

hearing

developmentally appropriate expressive/receptive language measurement language sample

OME

DDK

single word articulation test

formal or informalphonological analysis: syllable and word shapes

phonetic inventory:isolation/stimulability

vowel/diphthong inventory: isolation and syllables

prosodic analysis

assess inconsistency of production:repeated trials

volitional non-speech movements of oral muscles

• speech production tasks graded forom simple to more complex
• the effect of context on speech accuracy
• observation of performance on repeated productions of the same target
• documentation of differences between elicited or imitated productions vs. volitional and spontaneous
• analysis of types of errors, omissions,distortion and subsitutions
• observation of prosody
• observations of nonspeech movement sequencing(bite, blow)