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ASSESSMENT OF ORGANIC AND NEUROGENIC SPEECH DISORDERS

This comprehensive guide covers the assessment of organic and neurogenic speech disorders in patients with Cerebral Palsy (CP), Dysarthria, Childhood Apraxia of Speech (CAS), and Cleft Palate. It discusses the types of speech problems, characteristics to look for in assessment, associated problems, and assessment strategies. The text explores oral motor, feeding, resonance issues in CP; breathing, phonation, articulation in Dysarthria; inconsistent errors, prosody in CAS; and difficulties with pressure consonants, nasal emission in Cleft Palate. Assessment techniques, including evaluating pitch, loudness, prosody, intelligibility, connected speech samples, and more, are detailed.

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ASSESSMENT OF ORGANIC AND NEUROGENIC SPEECH DISORDERS

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  1. ASSESSMENT OF ORGANIC AND NEUROGENIC SPEECH DISORDERS

  2. 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)

  3. Fogle, 2019—CP often results from:

  4. Types of CP:

  5. 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

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

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

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

  9. 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

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

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

  12. B. Associated Problems

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

  14. CAS Assessment (continued)

  15. 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

  16. 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

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

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

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

  20. Cleft uvula alone**

  21. Cleft of the hard palate**

  22. **

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

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

  25. Unilateral cleft of the lip and palate**

  26. Unilateral cleft palate and lip**

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

  28. Bilateral combined**

  29. Bilateral combined**

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

  31. Surgical repair “after”**

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

  33. 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

  34. 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

  35. 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

  36. 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

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