Assessment of Language DisordersAssessment Protocol.docx

Assessment of Language Disorders
Assessment Protocol
Referral / Screening
Comprehensive Language Evaluation
Diagnosis
Referral made general when children are not meeting milestones
or show evidence of ID; wait and see approach something we do
not advocate
4
Screening
Tool for determining the need for a language assessment,
designed to determine if child has problems using or
understanding language

Occurs either after a referral or as part of regular screening
programs in schools
7.39
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Screening Includes:
Hearing screening
Gathering information through conversation with teachers and
family
Informal measures
Observation of spontaneous speech/ interaction with peers
Quick look at expression, comprehension and pragmatics
**after screen make recommendations for assessments
S/L Screener
Go to Head Start Screener
http://www.midlandesa.org/
Comprehensive Language Evaluation
Develops a profile of individual’s language skills, and identifies
methods of improving language form, content, and use

Includes the following:
Case history
Interview
Comprehensive testing & analysis
Evaluation of collateral areas
7.40
Justice
Case History/ Interview
Northeast Case History
Comprehensive Testing
Comprehensive Evaluation must be:
Broad Based: exams all domains of language in both
comprehension and production
Functional: measures their ability to function at home, school
and community
Utilize multiple methods of inquiry (utilizing criterion
referenced, norm referenced, dynamic assessment &
observational measures)
All domains (use, content, form); for children without speech,
look at babbling, jargon, gesturing, affect, joint attention,
intention etc; older children includes reading and writing as
well
Functional: how well do language skills assist children in

getting their needs met, interact with peers/friends, succeed in
school
Criterion referenced—percentage of how well one can complete
a task; norm referenced (lang skills compared to norms),
dynamic (performance with different types of assistance)
observation (naturalistic environment)
11
Norm Referenced
CELF-5 (Clinical Evaluation of Language Fundamentals):
provides language scores on core, receptive, expressive,
content, structure and memory
Braken Basic Concepts Scale: concepts of color, letters/sounds,
numbers/counting, size, shape, direction/position, self/social
awareness, texture/materials, quality, and time/sequencing.
https://www.bing.com/videos/search?q=braken+basic+concepts+
scale&&view=detail&mid=4EAF8158DD9C5FE512FD4EAF815
8DD9C5FE512FD&&FORM=VRDGAR (braken basic concepts
scale—up tp 3 min)
Play Based Assessment
https://www.youtube.com/watch?v=NJYoKpjd1dk
https://www.youtube.com/watch?v=oA5bkoY2H7o (PLS)
Evaluation of Collateral Areas
Are other areas present that impact language?
Cognition
Oral motor structure/function
Hearing
Cognition- milestones of play development or brief intelligence
screens

14
Diagnosis
Is a language disorder present?
Is the language disorder significant?
Diagnosis includes:
Type of impairment (primary, secondary)
Impacted domains (form, content, use; expressive vs. receptive)
Severity (mild, moderate, severe, profound)
Prognosis statement
Recommended course of treatment
7.41
Justice
**looking at the data you collected as evidence?
Importance of Correct Diagnosis
False-positives
False-negatives
7.42
Justice
False-positive

Due to poorly constructed tests
misdiagnosis language differences for disorders
Implications: an inappropriate label, expensive and time-
consuming treatment process
7.42
Justice
False-negative
Also due to poor tests or tendency to mistake another disorder
for a language disorder
Implications: children are not receiving the services they need
and are entitled to by federal law
7.42
Justice
Things to Consider
Treatment Targets
What element of language do you want to address?
Treatment Strategy
How are you going to go about helping the patient reach their
targets?
Treatment Context

In what setting are you going to treat a patient?
Treatment
Targets:
What are the impairments and what intervention is required?
How many goals are to be addressed at ones (1/2 at a time vs.
many goals).
**goals can be addressed at the same time ie: pragmatics–
initiation, turn taking, topic maintenance
20
Treatment Strategies
Child-centered approach
Child chooses materials, SLP seeks ways to facilitate language
Clinician Centered Approach
Adult selects activities & materials
Purposefully addresses treatment targets
Treatment Contexts
At home
In Classroom
Pull out method (in school)
In Speech & Hearing Clinic/ Private Practice
**Collaborative classroom model where teacher and SLP work
together
22
Expressive LanguageReceptive LanguagePragmaticsWhen

presented with 10
object/pictures, STUDENT will state appropriate function with
80% accuracy for 4 out of 5 sessions.
After listening to a story
with pictures, STUDENT will use spoken
Verbs to tell action
with 80% accuracy for 4 out of 5 sessions.
Given pictures, STUDENT will
Create an original spoken sentence using
Past progressive verb tense
(e.g., “The boy was walking”, “The ducks were swimming”)
with 80% accuracy for 4 of 5 sessions
When given 10 (2)step directions, STUDENT will follow the
directions with 80% accuracy for 4 out of 5 sessions
After listening to a story, STUDENT
will select the picture that tells
Where with 80% accuracy for 4 out of 5 sessions.
After given a spoken phrase/sentence that uses present tense “s”
and “es”
Marker (e.g., “The girl walks”, “The bee
buzzes”) STUDENT will indicate by saying ‘yes’ or ‘no’ if
the phrase/sentence includes the tense correctly with 80% for 4
of 5 trials.
STUDENT will introduce
HIMSELF to 5 people without cues
using appropriate volume,
eye contact, etc. 8/10
times over 5 sessions.
STUDENT will role-play 10 various situations in order to use
language skills for convincing/persuading
(i.e. convince mom you need to
go to the mall) 4/5 times over
5 sessions.
When verbally presented with examples of inappropriate
behaviors or reactions,
STUDENT will give an appropriate solutions 8/10 times over 3

sessions.
Evidence Tells Us...
Interventions are effective for children with expressive
language difficulties
Interventions are less effective for children with receptive
language difficulties
Having normal language peers in the environment has a positive
effect on therapies
Treatment Plan
“Guide” to a particular child’s treatment targets, strategies, and
contexts
Should be updated periodically throughout intervention as
children progress
7.46
Justice
Individualized Education Program (IEP)

Includes:
Series of measurable annual goals
Short term objectives (meant to build to annual goals)
Description of services, programs and aids
https://www.bing.com/videos/search?q=IEP%2bSLP&&view=de
tail&mid=D7AFFD9D3BB69814300DD7AFFD9D3BB69814300
D&&FORM=VDRVRV
Intervention Principles
Curriculum Access: strengthen aspects of language that will
facilitate academic curriculum
Career Development: assist language that supports interviewing
techniques, employment setting role play, create resume etc
Discourse Level Skills: support langauge required for
instruction in the classroom
Least Restrictive Environment: children with disabilities to be
educated with their peers to the “maximum extent possible”
LRE: keeping in public schools, inclusion classrooms, restrict
amount of pull out
27
Therapy Examples
Picnic (ASD):
https://www.youtube.com/watch?v=fQ7wvowhgXM
Downs Syndrome:
https://www.youtube.com/watch?v=oQApuymPQlM

Speech Sound Disorders
SLHS 1150

Speech Sound Disorder
Articulation Disorder (phonetic)
Phonological disorder (phonemic)
Motor Speech Disorder (dysarthria/apraxia)
Obligatory Tube of You Video
https://www.youtube.com/watch?v=UASW6zSuXaE

3
Phonology
Rules for combining and using sounds in order for the sounds to
convey meaning.
Do sounds make sense on their own?

Distribution & sequencing of sounds
Some sounds only occur at the ends/beginnings of
syllables/words
e.g., “ng,” “str”
Sounds change according to context
Accents, dialects
**some sounds may not go together
5
Phonological Development
Children have to…
Acquire all phoneme representations
Distinguish phonemes
Phonological Awareness
Phonological Disorder: Inability to correctly produce sounds of
words-- changes a words meaning

6
Phonological competence; look back at the stages of
development
What Is A Speech Disorder?
Articulation: movement of the tongue, lips, jaw and other
speech organs in order to produce speech sounds
Speech disorder: inability to produce sounds correctly/fluently
or a voice problem
7

Articulation/Phonological Disorder?
Articulation/phonological disorders are both speech sound
disorders but…
AD: physical etiology, sounds are consistently absent or
distorted (at site of speech output)
8
Articulation/Phonological Disorder?
PD: impairment of phonological system with patterns of sound
errors
1) resulting in significant problem producing speech sounds
2) differing from age- & culturally-based expectations

9
Phonological Disorder
Problem with perceptual representation
Child does not know that s/he needs to make a sound or group
of sounds
Child does not realize that leaving out the group of sounds can
change the meaning of a word
A phonological disorder can be distinguished from other motor
speech disorders- apraxia /dysarthria
10

Articulation disorder
Child does not have the ability to make the sound. It is
consistently absent in all places word-wise.
Does not change meaning differences
Articulation disorders
Child substitutes labial stops for velar stops all of the time
No correct production of /g/ and /k/
bag --> bab
tack --> tap
girl --> birl
cup --> bup
Child does not have the sound in her inventory

https://www.youtube.com/watch?v=6Pw6_tHmztk
Phonological Processes
Fronting
“tar” for car
Final consonant deletion
“ca” for cat
Weak syllable deletion
“jamas” for pajamas
Reduplication
“wa-wa” for water
Diminutizations
“blankie” for blanket
Cluster reduction
“tick” for stick
Gliding
“wabbit” for rabbit

Phonological disorders
Child substitutes /p/ and /b/ for /g/ and /k/, but only in word-
final position
“velar fronting”
bag --> bab
tack --> tap
girl --> girl
cup --> cup
Child has the sound in her inventory, but has different
phonological rules for when to produce it

Phonological disorders
Child substitutes stops for fricatives, but only at the beginning
of words
“stopping”
sun --> ton
fish --> pish
bus --> bus
leaf --> leaf
Child has the sound in her inventory, but has different
phonological rules for when to produce it
Phonological Disorder

https://www.youtube.com/watch?v=rW1HCT7yH8g
“Key Concepts”
Phonemes:
40 in Standard American English
Allophones: Variations in phonemes that do not change meaning
(/p/ in pat vs spin)
Coarticulation: ways sounds overlap during articulation;
characteristics vary /t/ tea vs. too
Assimilation: features of sounds take on features of neighboring
sounds
Ice vs nice: the [i] becomes nasalized in nice

Pronunciation
Place: where
(bilabial, alveolar, velar etc)
Manner: how
(stops, fricatives, nasals)
Voicing
Voiced vs unvoiced
Cognates : same place and manner, different voicing (ie /b/ and
/p/)
Pull up picture of IPA

Vowels
Defined by:
Height of tongue
Advancement o tongue
Roundness of lips
Tension of articulators /I/ vs /i/

Etiology and Subtypes of Speech Sound Disorders
Unknown origin
Otitis media with effusion (OME)
Hearing loss
Structural/organic abnormalities
Miscellaneous disorders
24

Unknown Origin
CHARACTERISTICS:
Small phonemic inventory
Phoneme collapse
“I tawt I taw a puddy tat.”
Persistent error patterns
Unintelligibility
Intelligibility: degree to which speech is understand by
unfamiliar listener
Tweetie v. Elmer Fudd
By what age should children have all sounds?
25

Otitis Media with Effusion (OME)
Same characteristics as unknown subtype
Auditory deprivation: Lack of auditory input
Fluid in ear muffles input
27
Structural/Organic Abnormalities
Structural Defects
Teeth: poor positioning, missing
Tongue: too small/big, cancer patients

Lips & Palate: clefts
28
Structural/Organic Abnormalities
Cleft palate
Problems w/ valving & pressure
Consonant distortion
Small inventory

29
Assessment
Determine:
Presence of disorder
Etiology
Affected sounds
Treatment
30
Assessment
Oral mechanism screening
Structures, movement
Spontaneous speech sample
Why do this?
Formal test of articulation
Evaluate all sounds in native language(s)
Informal test: stimulability
Extent child can produce new sound with help
Can target be produced with use of cues?

31
The Goldman Fristoe
Easel-style book with 43 picture plates
53 target words
61 consonant sounds in the initial, medial, and/or final positions
16 consonant clusters in initial position
Prompting and re-cueing
Easy to score

32
Tube of You Video
Administering the Goldman Fristoe
33
Why we like the Goldman Fristoe
Easy to administer
Covers most phonemes
Easy to score
Provides a thorough description of articulatory performance
Can be used to plan therapy

Limitations of the Goldman Fristoe
Hard to score in real time
Does not rule out a phonological disorder
Some pictures can be hard to name
Treating Articulation Disorders
Drilling
Oral Motor Exercises

“Traditional method”
Identify the typical sound
Discriminate it from the error
Vary and correct the atypical production until the sound is
produced correctly
Strengthen and stabilize that sound in all different contexts
Beginning, middle, end
Surrounding different vowels and consonants
Drills
A highly structured activity in which the professional guides the
client in the behavior that is expected.
Drilling is great
Because it’s essentially the fastest route to behavior
modification
Drilling is terrible
Because it’s not interesting for client or student
GAMES, PLAY, COMPETITIVE ACTIVITIES

There are tons of ways to do this…
sh
sea

Oral Motor Exercises
Techniques that aren’t producing speech sounds, but have a goal
of improving speaking abilities
Popular method, 85% of clinicians used OME in 2008
THERE IS LITTLE EVIDENCE TO SUPPORT THIS METHOD
AS A WHOLE
44

Treatment of Phonological Disorders
Minimal Pairs: use of a pair of words that differ by only one
phoneme
*Minimal Contrast Approach
*Maximal Opposition Approach
Metaphon Therapy (phonological awareness approach): Phase
one focuses on metalinguistic awareness & phase two applies
knowledge to more realistic communication
Cycles training: for highly unintelligible children;
phonemes/processes targeted for a set amount of time before
addressing a different one
Minimal vs maximal: difference is choice of words and
differences in distinctive features
46

Minimal pairs
47
Metaphon therapy—teaching metalinguistic knowledge
48
Language Disorders

Review
Speech:
Breath Stream
Voice
Articulation
Fluency
(Phonological disorders, MSD)
Language:
Form
Content
Use

Review
Speech:
Breath Stream
Voice
Articulation
Fluency
Language:
Form

Speech more muscular; language cognitive linguistic; deals with
symbolic representations
Language Development
Stages of Vocal Development:
-Phonation (0-2 month)
-Gooing and Cooing (2-4 months)
-Expansion Stage (4-6 months)
-Babbling (6+ months)
Jargon (10+ months)
First Words (12+ months)

Language Development- Review
Intentional Communication (7+ mos):
beginning of reciprocity (eye gaze,
pointing, gestures)
Transition to symbolic representation around 12 mos (utilizing
words for ideas)

Milestones in Toddlerhood
Achievements in Form:

-transition to multi-word utterances
**increasing Mean Length Utterance
-distinct grammar that governs word order
Achievements in Content:
-vocabulary spurt (“naming explosion”)
-receptive lexicon much greater than expressive
lexicon
Achievements in Use
Use a variety of language functions
(still learning to responds appropriately, keep listener in mind,
maintain topic)
Justice

Overextension vs underextension
Milestones in Preschool
Achievements in Form:
-grammatical & derivational morphology
-sentence complexity
2.37
Justice
Achievements in Content:

-Lexicon development: average of 13,000 words by
kindergarten
-Decontextualized language
-
Achievements in Use:
-Even more language functions: including interpretive,
logical, participatory, and organizing
-Turn-taking skills

Decontextualized language: language outside of the here and
now
Language Delay
“late start” with language development
“late talkers”
Will generally catch up to peers by entrance to primary school.
**if children do not “catch up” gap between their skills and
skills of peers begins to widen

Language Disorder
When an individual exhibits significant and persistent
difficulties with the comprehension or expression of spoken or
written language.

Language Disorder
The disorder is somehow impacting:
Form
Content
Use

Things to Consider (outside of the theoretical):
Extent observed/suspected language problems negatively impact
social, pyschological or educational aspects of child’s life
Differentiate between language disorder and language
difference
Deciding if language problems are significant enough to be
considered a disorder

Describing Language Disorders
Significant
Persistent
Reception
Expression

Spoken
Written
Language Delay
Language Impairment
Language Disorder

Language Disorders
Have an impact on a person’s life:
Social
Psychological
Educational

Primary vs. Secondary
Primary Language Disorder

Primary Language Disorder
Occurs without any other disability that would be accountable
Developmental Language Disorders

Secondary Language Disorder
Occurs as a consequence of another disorder:
Intellectual Disability
Hearing Loss
Autism Spectrum Disorder

What is Language?
Language is:
Shared code
Symbolic

Arbitrary
Multi-modal
Rule-Governed

A Shared Code
English Speaker
Spanish Listener
English Speaker
English Listener
Share the same code
Do not share the same code
“bathroom”
“bathroom”

Symbolic
Symbol: representation of something else

Arbitrary
No necessary or absolute connection between symbols and the
thing they represent
“Dog”
“Chien”
“Perro”

Multi-modal
Expressive language: Encoding
Speech
Gesture
Writing
Receptive language: Decoding
Listening
Watching
Reading

Language Disorders
Classification of language disorders focuses on three key
features:
Etiology
Manifestation
Severity

Etiology
Primary language impairments: language difficulties in the
absence of any other disability that can be held accountable
Secondary language impairments: language difficulties that are
a consequence of another disorder, intellectual disability, brain
injury, etc.

Etiology
Developmental: disorder that is present from birth
Acquired: disorder that is acquired sometime after birth, result
of some insult or injury

Acquired: lead exposure, TBI
Manifestation

Reception vs. Expression:
Language comprehension/reception disorder
Expressive language disorder
Mixed receptive-expressive disorder

Manifestation
Disorder of form:
syntax, morphology, and phonology
Disorder of content:
semantics
Disorder of use:
pragmatics

Manifestation
Focal disorders = only one domain affected
Diffuse disorders = multiple domains affected

Severity
Ranges from mild to profound
Mild: relatively little impact on a child’s ability to function at
home or school
Profound: may have no language skill at all and therefore may
be severely limited in ability to participate in activities at home,
school, or in the community

Common Disorders
Specific language impairment (SLI)
Autism spectrum disorder
Intellectual disability
Traumatic brain injury

SLI
Children who show significant impairment of expressive and/or
receptive language that cannot be attributed to any other cause
Diagnosed after age 3, to rule out just “late talkers”
Diverse group – some show problem in only one area and some
with problems in all areas of language
No known cause, but probably genetic

SLI
Not attributed to:
Low intelligence
Neurological impairments
Motor or sensory disturbances
Hearing loss

Etiology- most likely genetic:
Environmental factors (amount of language input)
Biological factors
Perinatal influences (premature, low birth weight)
Postnatal (nutrition, exposure to toxins)

SLI
Difficulties:
**Inconsistent skills across different language domains
*Slow vocabulary development
**Problems with word finding
*Problems with grammar
**Problems in social skills, behavior, and attention
https://www.youtube.com/watch?v=Pqu7w6t3Rmo

Autism Spectrum Disorder
ASD prevalence (NIH, 2014):
1 in 58 (1 in 38 males; 1 in 150 females)
Umbrella term for describing variety of developmental
characteristics marked by:
Difficulty with social interactions
Engagement of repetitive behaviors
Restriction of interests
https://www.youtube.com/watch?v=x2hWVgZ8J4A

ASD Etiology
Organic brain abnormality
Risk factors:
Maternal Rubella
Anoxia
Encephalitis
Sensory neglect
**no reliable link seen between vaccinations and the
development of ASD; continues to be a focus of research

Rubella=german measles
ASD- DSM V Diagnostic Criteria
Symptoms must emerge during childhood
Symptoms must affect individual’s everyday functioning (ie
social/occupational)
Symptoms include problems with social interaction
(conversation, initiation, understanding nonverbal
communication)
Symptoms include restricted and repetitive patterns of behavior
(repetitive speech, fixed interests, hyperawareness to sensations
in environment)

ASD- SLP focus
Communication: understanding/using words & gestures,
following directions, reading & writing, askng & answering
questions, participating in conversation, use of AAC if needed

Social Skills: joint attention, turn taking, understanding how
others may feel
Eating: assist in diet modification and increasing child’s ability
to try new food
Treatment Team includes: Psych, SLP, OT, PT, dietician,
developmental specialist, teachers and aides

Condition of arrested or incomplete development of the mind
Prevalence:
Approx 1.83% children (ASHA, 2011)
Causes:
30-40% have unknown etiology
65-75% biomedical or psychosocial
Prenatal (brain malformation, maternal disease, toxins)
Perinatal (labor related events/ anoxia)
Genetic (Downs Syndrome/Fragile X)
Environmental influences (sensory/social deprivation, toxins)

Co-occurrence & Comorbidities:
ASD
CP
Downs Syndrome
Fetal Alcohol Syndrome

Fragile X
Anxiety Disorder
Bipolar Disorder
ADHD/ADD
And more…

IDD Defining Characteristics
Diagnosed before age of 18
Mental abilities (intelligence) below average
Limitations of adaptive behavior:
Difficulty mapping behaviors and actions to any given situation

IDD Defining Characteristics
Decreased Conceptual Skills
Communication
Functional academics
Health & Safety
Decreased social skills
Social relationships
Participation in leisure activities
Decreased practical skill
Self-care
Home living
Community participation
https://www.bing.com/videos/search?q=intellectual+disability&
&view=detail&mid=31816E20DFF575BB04E031816E20DFF57
5BB04E0&&FORM=VRDGAR

Language Presentation
ClassificationIQ RangeLanguage SkillsMild ID50-69%Adequate
language skills
Good Social Relationships
Mild to moderate learning disability
Acquires academic skills @ 6th grade level
Moderate ID35-49Significant difficulties across various areas
Functional language and communication
Requires support in community and in employment

**Language/ Communication skills depends on severity and
presentation of IDD;
**can plateau at times with slow rate of development; can see
regression in some presentations, especially in degenerative
diseases
Mild: difficulty with abstract concepts, figurative language,
complex syntax, complex conversational participation
Moderate: (Cheryl & Uncle Al)– basic skills (basic arithmetic
and reading)
Language Presentation
ClassificationIQ RangeDescriptionSevere ID20-34Significant
delays across multiple areas
Very little language or ability to communicate with others
Use of AAC or sign
Continuous support required for community activitiesProfound
ID<20Severe limitations in self care
Very limited communication
Requires constant aid and support

Any type of damage to an individual’s brain
Occurs after birth
**The leading cause of death & disability among young
children

Causes
Transportation related accidents
Accidental falls
Recreational accident
Infection (i.e. meningitis)
Disease (i.e. brain tumor)
Physical Accidents (i.e. abuse, intentional harm, accidental
poisoning)

Receptive/Expressive Language: anomia, organization, fluency
Pragmatics: Initiation, Maintenance, turn taking
Speech: apraxia/dysarthria
Cognition: processing time, following direction, STM,
concentration
Receptive/Expressive Language
Cognition

Pragmatics
Speech
Voice
Swallowing/Feeding
Behavioral
Language disorders from brain injuries are influenced by:
Severity of the injury: more severe the injury, the less chance of
a full language recovery
Site of the damage: often affects the frontal lobe, causing
impairments in language use, and cognitive, executive, and
behavioral functions
**Characteristics of the child before the injury
7.35
Justice

Motor coordination can be difficult
Theophilus Thadeus Thistledown,
The successful thistle-sifter,
While sifting a sieve-full of unsifted thistles,
Thrust three thousand thistles through the thick of his thumb.
Now, if Theophilus Thadeus Thistledown,
The successful thistle-sifter,
Thrust three thousand thistles through the thick of his thumb,
See that thou, while sifting a sieve-full of unsifted thistles,
Thrust not three thousand thistles through the thick of thy
thumb.
Think about all of the separate targets you have to hit and how
quickly your tongue needs to move in order to say this fluently–
it is not always the easiest thing in the world and at times, we
miss our targets
2
The more difficult the task, the harder motor coordination is
Dearest creature in creation

Studying English pronunciation,
I will teach you in my verse
Sounds like corpse, corps, horse and worse.
I will keep you, Susy, busy,
Make your head with heat grow dizzy;
Tear in eye, your dress you'll tear;
Queer, fair seer, hear my prayer.
Pray, console your loving poet,
Make my coat look new, dear, sew it!
Just compare heart, hear and heard,
Dies and diet, lord and word.
.
“The Chaos” (1922)
Gerard Nolst Trinité
1870-1946
His poem features 800 of the worst irregularities in English
spelling & pronunciation
Pronunciation can also become difficult due to the irregularities
of the English language
3
Motor Speech Control
Individual control over muscular coordination involved in
producing speech
3 areas of deficits:
Planning
Programming
Execution

The motor plan specifies the movement goals with respect to the
articulators; the motor program specifies which muscles will be
used in moving the relevant articulators specified in the motor
plan. So in order to make the /s/ sound, for example, you have
to move your tongue up to the alveolar ridge. It's a tongue-tip
movement where contact is made between one articulator, the
front of the tongue, and another articulator, the alveolar ridge.
So, planning the movement at that level is motor planning. But
specifying which particular muscles are going to make the
tongue move to that location is done at the speech motor
programming level. There is what is called motor equivalence,
which means that you can achieve the same movement goal with
potentially infinite number of muscle contractions. Once you
know what the goal is at the anatomic structure level, then you
need to figure out how to make it more concrete and specific in
terms of the muscles involved.
Execution depends on the actual integrity of those muslces
4
Motor Speech Disorder
Speech production deficit resulting from a problem in speech
motor control
Deficit in speech, not language
Other oral movement impairment (eating, facial emotion) can
co-occur

Ability to build your message; know what you want to say in
intact—the ability to appropriately plan/program and execute
the muscle movements to adequately achieve speech is impaired
You know you want to complete an activity-such as walk across
the room– and your plan is to pick one leg up and then put it
down, so on and so forth; the programming is the actual
building of which message to send to which muscles in order to
complete the plan—the execution is carrying out the plan (if the
muscles in your leg is weak, you will not be able to carry out
movements
5
Systems involving speech
Which system specifically involves the brain, spinal cord,
cranial nerves, spinal nerves?
Respiratory System
Phonatory System
Articulatory System
Resonatory System
Central & Peripheral Nervous System
Which system specifically involves the brain, spinal cord,
cranial nerves, spinal nerves?
Respiratory System
Phonatory System
Articulatory System
Resonatory System

Which system specifically involves head and neck cavities and
the velopharyngeal port amongst others?
Respiratory System
Resonatory System
Phonatory System
Articulatory System
Which system specifically involves head and neck cavities and
the velopharyngeal port amongst others?
Respiratory System
Resonatory System
Phonatory System
Articulatory System
Which system specifically involves the larynx, pharynx, &
trachea?
Respiratory System

Phonatory System
Articulatory System
Resonatory System
Which system specifically involves the larynx, pharynx, &
trachea?
Respiratory System
Phonatory System
Articulatory System
Resonatory System
Brain, spinal cord, cranial nerves, spinal nerves
Respiratory System
Trachea, lungs, diaphragm, abdominal muscles
Phonatory System
Larynx, pharynx, trachea
Articulatory System
Articulators
Resonatory System
Head and neck cavities, velopharyngeal port

Central Vs. Peripheral
1. Brain
2. ????
3. ????
????? Nerves
Spinal Nerves
Central Vs. Peripheral
1. Brain
2. Brain Stem
3. Spinal Cord
Cranial Nerves
Spinal Nerves
Speech Sound Disorders

Anatomic/sensory—ankyglossia or tongue time, when
frenulum—piece of skin between the tongue is either too thick,
too short or both, affecting ability to articulate; cleft palate in
the incomplete closure of the hard/soft palate affecting one’s
resonance and ability to build enough pressure in order to
adequately produce a speech sound.
Execution—problem with muscle tone / could be due to paresis
(muscle weakness) or paralysis (complete inability to move)--
may be due to difficulty in programming/accurately
coordinating muscles
Planning/programming-difficulty in the conceptual planning of
the sequence of movements needed to complete speech (able to
build the message with language and cognition but cannot plan
the movements correctly)—determines, tone, range of
movement
15
Speech Motor Control
Muscles must coordinate:
Breathing
Voicing
Appropriate “shunting” of sound
Coordination of the articulators
Need to be able to take in an adequate breath as well as exhale
in a consistent even and slow manner to sustain voice and

loudness
Need to “turn on” vocal folds as soon as the exhaled breath
reaches the level of your vocal folds in order to optimize the
amount of words/speech you can get out of each breath
You need to be able to “turn on” and “turn off” voice as
necessary—adequate control of your vocal folds
You need to coordinate all of your articulators in time and space
in order to produce accurate sounds– remember coarticulation
and assimilation-the coordination and movement required for
each sound will be different depending on which environment/
which word you are producing it in (pool vs peel)
16
Speech motor Control
Ability to maintain speed, fluency and accuracy of movements
Motor Unit: “abstract representation of relatively invariant
movement patterns that can be scaled in size and time to meet
demands of a particular situation.
Seem to be planned/executed as a whole
Timing and force can vary
Ex: everyday motor movements such as running a race– pace
changes as you’re approaching the finish line
Motor unit– nerve cell that innervates multiple muscle fibers—
may want more information on this
17
Planning, Programming & Execution
https://basicmedicalkey.com/wp-content/uploads/2017/03/978-
1-60406-395-0_009_001.tif_epub1.jpg

Cognitive linguistic process--difficulty building your message
(finding the correct words, utilizing the correct syntax,
responding appropriately and on topic, ability to maintain
coherence and cohesion in answers
18
Motor Speech
Planning: processes that define and sequence articulatory goals
Motor Programming: processes responsible for establishing and
preparing the flow of motor information across muscles for
speech production and specifying the timing & force
Execution: processes responsible for activating relevant muscles
for speech production
Prevalence & Incidence
Incidence is unknown/complicated
Dependent on what’s causing the problem
148,000 diagnoses of motor speech disorder (2008 estimate)
Prevalence
Motor speech disorders (MSD) compose 51% of acquired
communication disorders

Etiology
Brain Injury
Stroke, TBI, Anoxia, Cerebral Palsy
Progressive Neurological Disorders
Parkinson’s, ALS, Huntington’s Disease, MS
MSDs are called either Developmental or Acquired
Anoxia-loss of oxygen to the brain; if the brain is cut off from
oxygen for 5 minutes, permanent damage can occur
CP- caused by damage to the brain before or at birth
21
Apraxia of Speech
Motor planning/programming disorder
Difficulty grouping and sequencing the correct muscles
Can be both acquired or developmental
“Simply, it is a disconnection between the brain and mouth-the
brain cannot plan the movement needed by
the speech articulators to accurately produce sounds and
words…”
http://nspt4kids.com/therapy/phonological-process-disorder-vs-
childhood-apraxia-of-speech-north-shore-pediatric-therapy/

Ability to linguistically represent a word/phrase, but are unable
to map it out ensuring appropriate execution
22
Apraxia of Speech
Looks like
Slow, effortful speech
Distorted Sounds
Groping of articulators
Impaired prosody
Difficulty with initiation
Errors vary between utterances
Often caused by
Damage to Broca’s Area
Premotor Areas
**often add different sounds, leave sounds out– some sound
distortions; Can co-occur with other motor speech disorders
(dysarthria) or language disorders (aphasia); Automatic speech
often easier (hello, how are you, counting to 10) May have more
difficulty when asked to do something
23
Childhood Apraxia of Speech
Difficulty with translation of linguistic representation and
motor movement

Difficulty learning motor behaviors
Same characteristics as AoS
Limited sound inventory, delayed speech development,
unintelligibility and slow progress in therapy
**Causes are not well understood**
Delayed first word, can only say a few vowels/consonants,
limited number of spoken word, difficulty getting
lips/jaws/tongue in correct position to produce a sound,
difficulty transitioning spmoothly from one sound to another
24
Videos
CAS
https://youtu.be/cEOy3APLA-g***
https://www.youtube.com/watch?v=cyb7esLHr7A (spontaneous
speech sample)
https://www.youtube.com/watch?v=rlciHHC0uT4
(spontaneous speech sample)
AoS:
https://www.youtube.com/watch?v=XVgzzoRBaVY **
https://www.youtube.com/watch?v=Ye2R86QLjYs
Dysarthria
Motor execution disorder
Disturbances in neuromuscular control
abnormal movement of muscles

Can be acquired or developmental
Many different types
Often caused by
Progressive disease or trauma
Progressive disease (ALS/parkinsons)
Trauma (TBI/stroke)
26
Results in Disturbances of:
Muscle tone: postural support
Muscle strength: ability to contract to desired level
Movement Steadiness: ability to generate steady movements
Movement speed: maintenance of appropriate speed
Movement range: how far structure can move
Movement coordination: appropriate timing of muscle
contractions
Low muscle tone—decreased resistance/tension within the
muscles may affect how you produce certain sounds
27
Breakdowns of Dysarthrias
Spastic
Flaccid
Ataxic

Unilateral Upper Motor Neuron (UUMN)
Hyperkinetic
Hypokinetic
https://upload.wikimedia.org/wikipedia/commons/5/55/Blausen_
0076_BasalGanglia.png
Need further information!!
28
CorticoSpinal Tract
#1 Function: Mediating Voluntary Movements
Aka pyramidal tract
White matter tract (made up of axons)
Descends from cortex or brainstem
Made up of Upper Motor
Neurons(UPM): UPM generally arise from premotor cortex &
motor cortex)
Signal from UPM are transmitted to Lower Motor Neurons
(LMN)
LMN transmit signal to the muscle
Basics:
Pyramidal System: voluntary pathway for all movement
Upper Motor Neurons (UMN): contained within the CNS;
paralysis causes spasticity

Lower Motor Neuron (LMN): second order/communication;
damage causes flaccid
Neuroscience!!
https://www.youtube.com/watch?v=Ma4i6nH3qMQ
31
Spastic Dysarthria
Hypertoniticity, reduced speed/range
Causes:
Bilateral damage to motor regions of the brain
Results in muscle contraction
Presentation:
Reduced speech rate
Distorted consonants and vowels
Reduced/exaggerated stress
Breathy/Harsh/Strained/strangled voice
https://www.youtube.com/watch?v=IXxruuFwue8

Damage to upper motor neurons
Increasd tone and limited range of movement
32
Flaccid Dysarthria
Hypotonicity, atrophy, muscle weakness
Causes:
Damage to Cranial Nerves, LMN, some areas
brainstem/midbrain
deficit depends on which CN is damaged
Presentation:
Reduced breath support
Breathy voice quality
Monoloudness & monopitch
Reduced articulatory precision
https://www.youtube.com/watch?v=dy8WvykiLto
33
Ataxic Dysarthria
Ataxic
Associated with cerebellar damage primarily impacting
articulation and prosody.

Can impact respiration, phonation, resonance and articulation.
Speech Characteristics:
Hoarse, breathy vocal quality
Tremors
Irregular/reduced articulatory pattern
Irregular speech rhythm
Unilateral Upper Motor Neuron (UUMN)
Damage to UMN pathway carrying impulses to CNs and spinal
nerves.
Deficits most apparent in articulation, phonation and prosody.
Harsh vocal quality
Reduced loudness
Irregular alternating rates
Hyperkinetic Dysarthria
Hyperkinetic
Typically associated with disorders of basal ganglia control
circuit (indirect motor loop), cerebellar control circuit or
extrapyramidal system.
Primary effects on rate and prosody
Sudden, irregular breathing patterns
Rapid bursts of speech

Sudden changes of pitch, loudness, and quality
Variable breakdowns of articulatory precision
Hypokinetic
Hypokinetic
“The dysarthria of Parkinson’s.”
Associated with impairments in basal ganglia control circuit
disorders.
Movements are “dampened.”
Reduced breath support, loudness
Rapid bursts of speech with long pauses
https://www.youtube.com/watch?v=ZXJ-khivLrU
Major Differences Across Disorders, IVerbal
ApraxiaDysarthriaSevere Phonological DisorderNo weakness,
incoordination or paralysis of speech musculatureDecreased
strength and coordination (leads to imprecise
production/slurring)No weakness, incoordination or paralysis of
speech musculatureInconsistencies in articulation
performanceArticulation may be noticeably “different” due to
imprecision, but errors generally consistentConsistent errors
that can usually be grouped into categories (fronting, gliding,
etc)
https://www.apraxia-kids.org/library/a-comparison-of-
childhood-apraxia-of-speech-dysarthria-and-severe-

phonological-disorder/
Major Differences Across Disorders, IIVerbal
ApraxiaDysarthriaSevere Phonological Disorder“Automatic” or
well-rehearsed speech is easiest to produce, “on demand”
speech most difficultNo difference in how easily speech is
produced based on situationNo difference in how easily speech
is produced based on situation
Number of errors increases as length of word/phrase
increasesMay be less precise in connected speech than in single
wordsErrors are generally consistent as length of words/phrases
increases
https://www.apraxia-kids.org/library/a-comparison-of-
childhood-apraxia-of-speech-dysarthria-and-severe-
phonological-disorder/
Research Paper Guidelines
1. Pick a disorder discussed in class. If you prefer to choose a
disorder that was not discussed, contact me to ensure it is
applicable.
2. Use 2 or more sources to research the etiology, presentation
and possible treatments of the disorder. One resource may be
your textbook.
3. Describe how gaining more information regarding this
disorder may have changed your perspective? Does this have
any affect on how you may interact with others in your future

career?
4. Paper should be 1-2 pages.
Correct grammar and the use of APA formatting will be
weighted in this assignment.
Due Date: Wednesday, November 20, 2019. (Printed, not
emailed please)
APA Guidelines:
http://www.easybib.com/guides/students/writing-guide/iv-
write/a-formatting/apa-paper-formatting/
https://owl.english.purdue.edu/owl/section/2/
Refworks—through library website
APA Manuals—library
Mendeley
Grading Scale:
Meets Requirements (10)
**1-2 pages
**Appropriate topic
**Organization (Please use paragraphs with intro and
conclusion!!)
**Neatness
**2+ Sources
Content (25)
**Sources relevant
**Demonstrates comprehension of topic

** Able to apply knowledge
Follows APA formatting (8)
Grammar/Proofreading (7)

Assessment of Language DisordersAssessment Protocol.docx

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Ähnlich wie Assessment of Language DisordersAssessment Protocol.docx

Ähnlich wie Assessment of Language DisordersAssessment Protocol.docx (20)

Mehr von festockton

Mehr von festockton (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Assessment of Language DisordersAssessment Protocol.docx