Unit Four
Articulation and
Phonological Disorders
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Chapter 9
Anatomy and Physiology
of the Articulatory System
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Biological
Function of the Mouth
• Eating
• Speech is an overlaid function
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Anatomy and Physiology
of the Articulatory System
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Facial bones and muscles
Mandible
Lips
Hard and soft palate
Tongue
Dentition
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Facial Bones
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Fontal bone
Temporal bones
Sphenoid bones
Zygomatic bones
Maxilla
Mandible
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Facial Muscles
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Buccinator
Depressor labii inferioris
Levator labii superioris
Masseter
Orbicularis oris
Risorious
Zygomatic major
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Mandible
• Lower jaw
• Largest facial bone
• Important for allowing mouth to open
and sounds to be amplified
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Hard Palate
• Roof of the mouth
• Contact point for tongue to produce
several sounds
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Soft Palate
• When soft palate is raised to posterior
pharyngeal wall
– Voice is directed into the oral cavity
– Articulators modify sounds to produce
consonants and vowels
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Lips
• Four movements involved in speech:
– Opening
– Closing
– Protrusion
– Retraction
• Important in producing several sounds:
p, b, m, w, f, v
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Tongue
• Three biological functions:
– Taste
– Movement of food while chewing
– Movement of food for swallowing
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Tongue
• Primary articulator
• Important in producing several sounds:
– Voiced and unvoiced ‘th’; t and d; k and g
– Voiced and unvoiced ‘sh’
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Tongue Tie
• Known as ‘ankyloglossia’
• Due to a restricted lingual
frenum/frenulum
• Reduces ability of tongue tip to elevate
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Muscles of the Tongue
• Eight pairs of muscles
• Extrinsic muscles
• Four pairs that help position the tongue
• Intrinsic muscles
• Four pairs that help shape the tongue
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Intrinsic Muscles
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Superior longitudinal
Inferior longitudinal
Transverse
Vertical
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Extrinsic Muscles
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Genioglossus
Styloglossus
Hyoglossus
Palatoglossus
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Tongue Thrust
• Resting the tongue against inner
surface of the front teeth or protruding
tongue between the teeth
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Dentition
• Primary teeth erupt between 6-9 months
• All 20 primary teeth have erupted by 1824 months
• 32 permanent teeth erupt between 6-13
years
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Bruxing
• Compulsive, unconscious clenching and
grinding of teeth
• Can wear down the edges of the teeth
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Dental Occlusions
• Class I
– Normal relationship
• Class II (overbite)
– Upper incisors are considerably anterior to
lower incisors
• Class III (underbite)
– Upper incisors rest behind the lower
incisors
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Chapter 10
General American
English Sound System
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Phonetics
• Study of speech sound production
• Study of symbols used to represent
speech sounds
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Phonology
• Study of the sound system and the rules
governing sound combinations
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International Phonetic Alphabet
(IPA)
• An alphabet for writing the speech
sounds of all languages
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Dialects
• A form of speech and language used in
a geographical area
• According to ASHA
– No dialect is a disorder or pathological
form of speech or language
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Accents
• Speech pronunciation and inflections of
nonnative speakers
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Accent
Modification Therapy Goals
• Reduce speech characteristics that
affect intelligibility
• Add speech characteristics to make
speech easier to understand
27
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American English Phonemes
• Speech sound in a language distinct
from other sounds in that language
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Classification of
American English Phonemes
• Place
– Location in mouth of articulators
• Manner
– Degree of narrowing
• Voice
– Whether the vocal folds are vibrating or not
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Place of Articulation
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Bilabial
Labiodental
Interdental
Alveolar
Palatal
Velar
Glottal
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Vowels
• Described by placement of tongue
during their production
31
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Chapter 11
Etiologies of
Articulation, Phonological,
and other Communication
Disorders
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Functional
vs. Organic Disorders
• Functional
– No known anatomical, physiological or
neurological basis for a disorder
• Organic
– An anatomical, physiological, or
neurological cause for a disorder
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Three Primary Etiologies of
Communication Delays/Disorders
• Normal variation
• Environmental problems
• Physical impairments
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Normal Variation
• Approximately 70 percent of children fall
within the typical range
• Only a small number fall outside the
typical range
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Environmental Problems
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Prenatal environment
Syndromes
Maternal substance abuse
Low birth weight and prematurity
Perinatal and postnatal environment
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Physical Impairments
• Traumatic brain injury
• Hearing impairment
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Integration of Factors
• We cannot determine a single factor as
a cause for most communication
problems
• Most communication problems are
multifactorial
– In many cases, the cause is unknown
38
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Chapter 12
Articulation Disorders
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Articulation Disorders
• Occur in 10 to15 percent of preschool
children
• 75 to 85 percent also have language
disorders
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Articulation Disorder
• Difficulty with the articulation of speech
sounds
• Implies a motor component to the
disorder
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Goals of the Assessment
• Describe development
• Determine if speech is sufficiently
different from the norm
• Identify factors related to the disorder
• Plan treatment
• Prognosis
• Monitor changes over time
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Assessment Protocol
• Case history
• Assessment of speech
– Screening and articulation testing
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Oral exam
Hearing and language assessment
Diagnosis
Written report
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Analysis of Data
• Number of errors
• Types of errors:
– Substitutions, omission, additions,
distortions
• Consistency of errors
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Stimulability
• Child’s ability to produce the correct
sound after cueing by clinician
• Stimulability indicates a better prognosis
for improvement in therapy
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Articulation Therapy
• SLPs need to be three people in one:
– Scientists
– Humanists
– Artists
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Treatment Efficacy
• Studies demonstrate that speech
therapy is effective in improving speech
sound production and intelligibility
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Traditional Therapy Approach
• Child is made aware of phoneme
• Child recognizes errors
• Child produces phoneme in isolation,
syllables, words, phrases, sentences
• Carryover
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Chapter 13
Phonological Disorders
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Phonology
• Study of the sound system of a
language and the rules governing sound
combinations
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Phonological Disorder
• Difficulty with the acquisition of a rules
underlying the sound system
• 80 percent of children with phonological
disorders also have language disorders
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Theories of Phonology
• Natural phonology
• Linear/generative phonology
• Nonlinear phonology
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Principles of
Phonological Assessment
• Transcribe the whole word
• Sample phonemes in a variety of
contexts
• Always sample continuous speech
• Determine stimulability
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Therapy Approaches
• Distinctive features
• Cycles approach
• Minimal contrasting pairs
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Distinctive Features Approach
• Teach children to produce specific
distinctive features
• Teach the rules for correct use of a
distinctive feature
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Cycles Approach
• Different phonological patterns are
targeted in specific time periods called
“cycles”
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Minimal Contrasting Pairs
• Create pairs of words where one word
has the correct phonological pattern and
the other word has the contrasting
pattern
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Chapter 14
Motor
Speech Disorders
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Childhood Apraxia of Speech
(CAS)
• A motor speech disorder in the absence
of muscle weakness
• Affects motor planning, sequencing,
coordinating and initiating motor
movements
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Speech Characteristics of CAS
• More errors with complex sounds
(fricatives, clusters)
• Errors increase with increasing length of
utterance
• Omissions
• Vowel errors
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Speech Characteristics of CAS
• Groping behavior
• Prosodic impairments
• Lack of progress with traditional
articulation or phonological therapy
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Assessment of CAS
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Case history
Hearing screen
Assessment of all speech systems
Articulation testing
Language testing
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Therapy for CAS
• Intensive
• One-on-one
• Progress through a hierarchy of task
difficulty
• Many repetitions
• Small increases in task difficulty
• Multiple modalities
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Childhood Dysarthria
• A motor speech disorder caused by
neurological damage prenatally,
perinatally, or postnatally
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Speech Characteristics
of Childhood Dysarthria
• It can affect each speech system:
– Respiration, phonation, resonation,
articulation
• Will affect the range of motion, strength,
coordination, and rate of movement
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Assessment
of Childhood Dysarthria
• All speech systems must be evaluated
individually and in coordination with
other systems
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Therapy for Childhood Dysarthria
• Primary goal of therapy is to maximize
speech intelligibility
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Cerebral Palsy
• Most common cause of dysarthria in
children
• Incidence is 1 in 500 children in
developed countries
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Types of Cerebral Palsy
• Children with too much muscle tone:
– Hypertonicity
• Children with too little muscle tone:
– Hypotonicity
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Classification of Cerebral Palsy
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Spastic
Athetoid
Ataxic
Mixed
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Spastic Cerebral Palsy
• Most common type
– 60 to 70 percent
• Hypertonicity
– Abrupt, jerky, labored movements
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Athetoid Cerebral Palsy
• 20 to 30 percent of cases
• Slow, continuous, involuntary
movements of extremities
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Ataxic Cerebral Palsy
• 5 to10 percent of cases
• Hypotonicity
• Impaired ability to coordinate
movements and maintain balance
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Mixed Cerebral Palsy
• Combination of different types
• Spasticity and athetosis is most
frequent combination
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Cerebral Palsy:
Speech/Language
• Moderate to severe unintelligibility
• Language and cognitive problems
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Cerebral Palsy:
Associated Problems
• Intellectual disabilities
– 75 percent of cases
• Hearing impairments
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Cerebral Palsy:
Associated Problems
• Visual impairment
– 71 percent of cases
• Seizure disorders
– Occur in 45 percent of cases
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Evaluation
• An interdisciplinary team is required
• Team will include SLP, OT, PT, and
other professionals specially trained to
work with children with cerebral palsy
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Therapy
• Team approach is required
• PT is usually the lead team member
• PT can help with best posture/positions
for the child to use in other therapy
tasks
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Chapter 15
Emotional and Social
Effects of Articulation
and Phonological Disorders
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Educational Effects
• Children may not speak in class
• Avoid peer interactions
• Seventy-five to eighty-five percent of
preschoolers and 50% to 70% of
school-age children also have language
disorders
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Speech Characteristics
• Two speech characteristics that attract
the most negative attention
– Conspicuousness of the disorder
– Degree of unintelligibility
• There are many overt and covert
‘penalties’ associated with impaired
articulation
82
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Articulation and
Phonological Disorders
• Children with articulation and/or
phonological disorders may be teased
because of their speech
• These children may develop negative
attitudes about themselves
83
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Articulation and
Phonological Disorders
• Children may be frustrated if they
cannot be understood by others
• Many children may choose to remain
silent rather than talk
• Parents report their children have
difficulties with social competence
84
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Unit 04 Articulation and Phonological Disorders