1. Cluster reduction ("try" -> "tie")
2. Weak syllable deletion ("banana" -> "nana")
3. final consonant deletion ("dog" -> "dah")

1. Omission
2. substitution

1. NUMBER of sounds produced correctly
2. ACCURACY of production
3. ABILITY to produce sounds in different word POSITIONS
4. ABILITY to produce sound SEQUENCES
5. ABILITY to produce various TYPES of words

• produces a few sounds in error
• usually involves a few of the "late 8" sounds (sh, th [voiced and voiceless], s, z, l, r, dʒ)
• generally INTELLIGIBLE to most speakers
  

Moderate

• difficulty producing all the sounds within a single CLASS (velars, final consonant deletion, incorrect use of sounds in certain word positions ["pod" instead of "pot"], cluster reduction ["bu" instead of "blue"])
• intelligible to friends and family members, but not unfamiliar listeners
• good PROGNOSIS, but longer TREATMENT

1. unintelligible to most listeners
2. more than SIX sounds in error in ALL positions of words
3. do not sequence sounds consistently
4. unintelligible to most listeners
5. may rely heavily on gestures to communicate

• bilinguals- phoneme differences in two or more languages (language differences in sound production -- NOT a disorder)
• dialects - vowel and consonant differences (shicken - chicken)

Perceptual Etiology

("etiology" = cause/causes)

1. dysarthria - neuromuscular impairment
2. apraxia - neurological damage

1. DETERMINE nature and severity of disorder/delay
2. DESCRIBE production/COMPARE speech patterns to others of same age (Speech samples, articulation tests, note presence of behaviors [pointing, visual gaze, gesures, etc.])
3. ASSESS contributing factors (hearing screening, oral-peripheral examination)
   

1. Teach motor movements necessary for speech
2. Repeat motor practice with feedback (levels: phoneme, syllables [initial position, final position], words [initial, final, medial], phrases, sentences)

Contrast therapy - show pictures representing word pairs that differ in one dimension

Nasality:

toe/no

pot/not

see/me

Final consonant deletion:

no/note

see/seat

me/meat

1. intervention programs in schools
2. private practice settings
3. rehab centers or hospitals

1. private practice settings
2. rehab centers or hospitals

• starts ~6 weeks after conception
• structures forming roof of mouth and face begin to grow closely and, if undisturbed, will unite to form palate and lip
• process complete = ~ 9 weeks

-alveolar ridge involved

-can affect speech

submucous cleft palate

*Definition

*characterized by...

almost all of the hard palate and almost all of the soft palate forms normally.

characterized by

1. notch in hard palate
2. middle of velum thin and bluish
3. bifid (divided) uvula

Clefts of the lip

*When they're repaired

*Type of surgery

Repaired surgically within first 3 mos. of life

Chelioplasty

Clefts of the palate

When they're repaired

Type of surgery

Typically repaired at 12 mos of age

palatoplasty

Assessment of cleft/lip palate

1. Team approach - SLP, surgeon, dentist, neurologist, prosthodontist etc
2. instrumental (nasometer)
3. observation & judgement (nasality/speech production

1. DENASAL as result of nasal structure distortions
2. HYPERNASAL as result of inadequate velopharyngeal closure
3. some can be BOTH hypernasal (on vowels) and hyponasal (on nasal consonants)

1. glottal stops
2. pharyngeal stops
3. pharyngeal fricatives
4. nasal emission

Pharyngeal flap

-reduce hypernasality/nasal emission

-flap of tissue from back wall of throat is raised and inserted into velum

-provides for constantly present veil over the velopharyngeal port

1. speech bulb or pharyngeal extention appliance (inadequate soft palate length, worn like retainer - extends to block space not covered by velum)
2. palatal lift appliance (adequate soft palate length, but lacks muscle control. Similar, but lifts flaccid velum up)

1. abuse/misuse
2. medical
3. psychogenic

1. edema - swelling of vocal folds (laryngitis)
2. atrophy (reduction of tissue)
3. hyperfunction - increased muscle activity
4. hypofunction - decreased muscle activity

1. aphonia - loss of voice
2. harsh voice - excessive muscle tension
3. breathy voice- partial whisper
4. hoarse- both breathy and harsh

1. conversion aphonia/dysphonia - psychogenic problem. Normal phonation in vegetative functions
2. puberphonia - high pitch voice by postpubertal male, easily corrected
3. muscle tension dysphonia - simultaneous contractions of adductors and abductors, type A personalities

1. paralysis- recurrent laryngeal nerve of vagus (x) damage (unilateral paralysis). Move the affected fold closer to midline
2. spasmodic dysphonia - Rare. Basal ganglia affected. Adductor SD - strain-strangle voice quality. BOTOX at 3-6 mos. interval

1. contact ulcers - ulcers on vocal processes of arytenoids. excessive slamming during low pitch, nonproductive throat clearing. coughing, gastric reflux, intubation.
2. nodules - callous-like growths. 20% of patients with voice problems. "screamers nodules". forms in pairs, greatest amplitude of vibration.
3. polyps - 10% of patients with voice disorder. blister like growths. unilateral.

1. papillomas - HPV. Wart like growths. Usually go away w/o treatment - if get too large, may compromise airway
2. carcinoma - 11,000 new patients each year. 75% are on vocal folds. exposure to inhaled smoke - smoking + drinking combo. 15-20% require laryngectomy

• best managed by team: ENT - SLP
• patient interview
• judgment of quality
• instrumental evaluation (endoscopy, stroboscopy, visipitch)

1. counseling
2. ear training
3. feedback
4. altering loudness
5. yawn-sigh
6. open mouth
7. respiration training

1. surigcal removal of larynx due to cancer
2. trachea redirected to stoma
3. tracheaesophogeal speech (thru tracheaesophogeal puncture [TEP])

1. esophogeal speech - air released near glottis
2. electrolarynx - handheld battery operated device, mechanical quality of voice
3. Tracheoesophogeal puncture (TEP)