Communication and Swallowing Disorders (Speech)

Speech Disorders .II.Speech disorders: 1. Dyslalia (Misarticulation): Definition: Faulty articulation of one or more of speech sounds not appropriate for age. Lateral sigmatism. B) Back-to-front dyslalia:/k/ /t/ /g/ /d/ C) Rotacism (/r/ defect).Pharyngeal sigmatism. . D) Voiced-to-nonvoiced dyslalia:/g/ /k/ /d/ /t/ /z/ /s/ etc… .Interdental sigmatism. .Types of dyslalia: A) Sigmatism (/s/ defect):. Diagnosis of dyslalia: I.Audiometry.Psychometry (IQ).Articulation test. History taking. II. . III. … Investigations: .Audio recording. . . tongue. Dyslalia Sheet . Physical examination: … . . Dental anomalies. .Management of dyslalia: Treatment of the cause: . Tongue tie. Speech therapy. Speech disorders: 2. and blocks. . Stuttering: Definition: The intraphonemic disruptions resulting in sound and syllable repetitions. sound prolongations.II. .Less than 6 years. . . .Not aware.Only repetitions.No associated muscular activity.Normal dysfluency: . . . Epidemiology: .can occur in mentally retarded. .Latest = 13 years.Incidence of stuttering: 1%.very rare in the hearing impaired. Onset: .Earliest = 18 months. .more in families with history of stuttering. Gender ratio: 4 : 1 (male : female) Theories of Stuttering: The exact cause is unknown.Neurosis theory. . .Organic theory. .Learning theory. . . . III. Psychometry (IQ).Stuttering severity (eg SSI). History taking.Articulation test. Stuttering Sheet . VPA.Diagnosis of stuttering: I.Audio and video recording. Physical examination: APA. … Investigations: . II. prolongation. Core behaviors: . .Auditory Perceptual Analysis (APA): A. interruption. . . Concomitant reactions: .Interjection. cessation.Prolongations. …). . . .Blocks.Repetitions. .Skin pallor/flushing.Fear. C. Secondary reactions: .Word substitutions and circumlocution. B. .Muscular activity and struggle. .Breathing (antagonism.Eye contact.Intraphonemic disruption. Management of stuttering: Family and patient counseling. b. Direct therapy: if aware. Indirect therapy: if not aware. . Speech therapy: a. It results from velopharyngeal insufficiency (VPI). .II.Speech disorders: 3. Hypernasality: Definition: Faulty contamination of the speech signal by the addition of nasal noise. . Structural: a) Congenital: .Palatal trauma.Non-cleft causes: .Adenotonsillectomy. Congenital short palate. .Palatal lower motor neuron lesion.Palatal upper motor neuron lesion. . . .Overt cleft palate.Submucous cleft palate. . Congenital deep pharynx. . Organic: 1. .Causes of hypernasality: I. 2. Neurogenic: . b) Acquired: .Tumors of the palate & pharynx. Non-organic (Functional): . .Neurosis or hysteria.Post-tonsillectomy pain. . . .Causes of hypernasality (cont. .Hearing impairment.Faulty speech habits.Mental retardation.): II. Language: DLD. . .Communicative problems: .Feeding problems: nasal regurgitation. .Ear infections (tensor palati: V). . Voice: hyper or hypofunction. .Psychosocial problems. . Speech: hypernasality.Effects of VPI: . Audiometry. History taking. .General. . II. - .Fiberoptic . Hypernasality Sheet . Czermak’s (cold mirror) test. III.. Psychometry (IQ). Physical examination: .Articulation test. . Investigations: nasopharyngolaryngoscopy. . palate (inspection.Simple tests: . .. .Audio recording.Diagnosis of hypernasality: I. Gutzman’s (a/i) test.ENT examination: …. palpation) .Nasometry. . Feeding.Team work. .Management of hypernasality: . Obturators. . Voice: Voice therapy. Maxillofacial. Hearing. . Speech: Speech therapy. Communication: Language: Language therapy. Palatal and lip surgeries. articulation. resonance. . that may result from a neuromuscular disorder. and prosody. Dysarthria: Definition: Any combination of disorders of respiration.II.Speech disorders: 4. phonation. . . . Spastic dysarthria: . * labored breathing.Lesion: upper motor neuron level.Communication: * strained strangled phonation.Types of dysarthria: 1. 2. Flaccid dysarthria: . * hypernasality.Lesion: lower motor neuron level.Communication: * breathy phonation. * irregular articulatory breakdown.Types of dysarthria (cont. . Ataxic dysarthria: . .Lesion: cerebellum level.): 3.Communication: * increased equal stresses. A. Quick hyperkinetic (Chorea): * variable rate and loudness. Dyskinetic dysarthria: .Types of dysarthria (cont.Lesion: basal ganglia level. B. Hyperkinetic type: i. ii. Slow hyperkinetic (Athetosis): * slow rate. . * rapid rate. Hypokinetic type (Parkinsonism): * breathy phonation.): 4. * short rushes of speech with final decay. .may the most common. Ataxic + Spastic + Hypokinetic. . Mixed dysarthria: . * Wilson’s disease ……….Examples: * Motor neuron disease .…Flaccid + Spastic.): 5... Ataxic + Spastic.Types of dysarthria (cont. * Multiple sclerosis ……. . .Aerodynamics (Aerophone II). Dysarthria Sheet .Audio recording. . . .Dysphasia test. … . . II.MDVP.Nasometry.CT/MRI brain . . . Physical examination: … . mouth. palate.Fiberoptic nasopharyngolaryngoscopy.Psychometry (IQ).Diagnosis of dysarthria: I. History taking.Audiometry. Investigations: . … III. neurological exam.Articulation test. Alternative and augmentative communication. Resonance. Respiration. Patient counseling. Prosody. * Articulation. Communicative therapy: Phonation.Management of dysarthria: Individualized: Management of the cause. * * * * .