ASSESSMENT OF ORGANIC AND NEUROGENIC SPEECH DISORDERS I

• ASSESSMENT OF ORGANIC AND NEUROGENIC SPEECH DISORDERS

I. CEREBRAL PALSY** • A. Introduction-definition (non-progressive motor disorder due to pre-, peri-, or post-natal damage) • Youtube—Charrise’s Story: My Life Journey with Cerebral Palsy (first few minutes)

Fogle, 2019—CP often results from: • Infantile hypoxia—partial or significantly diminished supply of oxygen to brain • Infantile anoxia—oxygen completely cut off

Types of CP: • Spastic: 50%; slow, jerky movements and increased muscle tone • Athetoid: 10%; slow, writhing, involuntary movements • Ataxic: 5 -10%; balance problems but normal reflexes and muscle tone • Rigid: 1%; simultaneous contraction of all muscle groups • Mixed: 30%; several types

B. Speech Problems and Their Assessment** • Oral motor—assess speech, nonspeech tasks • Feeding—sucking, chewing, swallowing • Slow DDK rates, discoordination of tongue • Resonance—nasal emission on consonants, hypernasality on vowels

• Prosody—monotone, monoloudness • Respiration—rapid breathing, waste of air, trailing off at the ends of sentences • Phonation—weak voice; strained if vocal folds are hyperadducted • Articulation—imprecise; weak pressure consonants

II. DYSARTHRIA** • A. Introduction • Neuromotor disorder affecting all systems: respiration, phonation, articulation, resonance, prosody • Due to: CP, degenerative diseases, stroke

B. Characteristics to Look for in Assessment** • Breathy respiration • Difficulty with appropriate syllable stress • Artic: imprecise, distorted consonants; weak pressure consonants

» Resonance: hypernasality • Phonation: monotone, monoloudness, often soft voice • PRAXIS tip: Festination means small, shuffling steps

III. CHILDHOOD APRAXIA OF SPEECH** • Youtube—childhood apraxia of speech 3 year old (Urban. Kowboy) • Youtube Severe Apraxia and Possible ASD (Julian)

2020 asha. org • CAS occurs in 1 -2 children per 1, 000 • Found in approximately 4% of ch referred for SSDs • Idiopathic CAS affects more boys than girls by a ratio of 2 or 3: 1

We know that: • Most ch with CAS have a family member with a speech or lang disorder • CAS has a genetic component

A. Introduction** • Inconsistent errors • Flat prosody • Difficulty sequencing sounds and syllables • Moderately to severely unintelligible

• CAS is not the result of neuromuscular weakness • Ch with CAS have impaired motor planning and programming capabilities • Unable to automatically learn motor plans necessary for rapid, accurate speech production • Better at word level than connected speech

True-False: • Childhood apraxia of speech is characterized primarily by weakness of the speech muscles and breathy speech.

B. Associated Problems • Family hx in some ch • Possible learning disability • Better receptive lang skills, ↓ expressive lang • Slow tx progress • Oral apraxia/difficulty with volitional nonspeech tasks • Slow DDKs • “Soft” neurological signs—gross & fine motor incoordination

C. Assessment—Evaluate: ** • 1. Pitch, loudness, prosody • 2. Overall intelligibility • 3. Resonance—e. g. , hypernasal? • 4. DDKs—alternating /pʌpʌ/ • and sequential motion /pʌtʌkʌ/

• CAS Assessment (continued) • 5. Sample production of same phoneme in multiple trials • 6. Ask them to produce words in both imitative and spontaneous modes • 7. Developmental hx— feeding, sucking problems? Slow lang devt. ?

CAS Assessment (continued)** • 8. Receptive and expressive lang skills • 9. Articulation—give test, administer items repeatedly to assess consistency of production • 10. Connected speech sample

One of my very favorites**: • 12. Production of polysyllabic words —have them say the words several times, check for consistency. E. g. : (words are not on test) • • • Expensive Refrigerator Buzz Lightyear’s Zurgotronic Ionblaster (ha ) Congratulations Cafeteria Computer

• Remember: inconsistency is a hallmark of CAS

IV. CLEFT PALATE (cleft is an opening in a normally closed structure)**

Youtube • LT 5 1/2 years old with cleft palate

A. Introduction-major categories** : • Isolated cleft lip

Cleft uvula alone**

Cleft of the hard palate**

Adult cleft of soft palate and part of hard palate**

Cleft of soft and hard palate**

Combined Cleft Palate and Lip** • This can be unilateral or bilateral • Here is a unilateral cleft

Unilateral cleft of the lip and palate**

Unilateral cleft palate and lip**

Example of a bilateral combined cleft lip and palate: **

Bilateral combined**

Bilateral combined**

Fortunately, surgical repair is excellent in the 21 st century**

Surgical repair “after”**

Surgical repair “after”** • He had 5 -6 surgeries, the last of which was in 6 th grade • He is now a model and actor

B. Assessment of Patients with Cleft Palate** • Difficulty with pressure consonants (stops, fricatives, affricates) • Nasal emission, hypernasality • Compensatory errors like glottal stops hoarseness • Middle ear dysfunction (Eustachian tube), OME

Test question: • Nadia, a 7 -year old with a partially repaired cleft palate, has immigrated with her family from Jordan. She is somewhat unintelligible. Which of the following probably is/are TRUE? • A. She has difficulty with pressure consonants • B. Pressure consonants in error include stops, fricatives, and affricates • C. She probably has a severe bilateral sensorineural hearing loss • D. A, B • E. B, C

• Iowa Pressure Test (part of the Templin. Darley) • Watch for expressive-receptive lang gap • Listen for vocal pathology like hoarseness, soft voice due to strain on vocal folds or to VPI (velopharyngeal inadequacy)

C. Assessment Strategies** • 1. Work with team of professionals • 2. Help plan surgical interventions • 3. Assess intelligibility in connected speech • 4. Esp. assess production of pressure consonants in words and sentences • 5. Determine presence of hypernasality on vowels and nasal emission on consonants

Hold a mirror under the child’s nose…** • Have her prolong /i/ • Also assess pressure consonants, look for fog • Mirror should be clear if there is no hypernasality