Communication Disorders


Importance of speech

  • Opportunities to interact are reduced 
  • Speech is a part of our identity 
  • Speech is:
    • How we recieve messages from others
    • A vehicle for self expression
    • A window into a persons thoughts 
    • A personal signature 
    • Superimposed on the normal pattern of exhalation and inhalation 
      • We breath in about 20 times a minute when not speaking and only 10 times a minute when speaking 
      • Must be able to control breathing pattern 
    • Primary function of vocal folds is that of protecting the lungs and their access, the tracheae, from the invasion of food and other foreign bodies 
  • Problems typically occur with disorders of:
    • Fluency 
    • Voice
    • Articulation 
    • Processing (phonological impairment)
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  • Dysrhythmia 
    • Phonetic interference with the normal rhythms of speech 
    • Stuttering and cluttering 
  • Stuttering 
    • 1 % of the population 
    • Developmental problem 
    • More likely to affect younger population
    • Boys out number girls 4:1 
    • 85% of all cases start in the pre-school year 
  • Characteristics of Stuttering 
    • Create non typical presentation of speech 
    • Abnormal amount of segment, syllable, word/phrase repetition 
    • Long pauses, sudden head and body movements 
    • Stop cycle: stop what they are doing 
    • Abnormal prolongation of sound segments 
    • Great use of fillers
    • Erratic stress pattern
    • Unfinished words 
    • Awkward circumlocutions 
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Causes of Stuttering

  • Great controversy about whether stuttering is a problem of speech, personality, neurology or psychology in childhood or occuring throughout life
  • Lack of cerebral dominance 
    • Dont have clear distinction between left and right hemisphere 
    • Overlap between brain functioning 
  • Inheristed predisposition 
    • Genetic makeup 
  • Environmental pressures
    • Something has made speech an unpleasant experience
  • Psychoneurotic pressure
  • Learning
  • Defect in auditory feedback mechanism
    • Can create a stutter causing a delay here  
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Characteristics of Cluttering

  • Opposite to stuttering 
  • Rapid, staccato speech so utterances come out in short bursts
  • Many distortions in rhythm, often monotone presentation
  • Poor articulation, sounds are misarticulated and omitted 
  • Words and syllables are telescoped to the point of unintelligibility 
    • Words on top of eachother 
  • Person has emotional reactions to their type of talking and often cope by not talking 
    • Selective mutism
  • Speech too fast: distorted 
  • Causes of Cluttering 
    • Few cues about origin 
    • May be a disorder of thought process preparatory to speech and is based on a heriditary disposition 
    • Cluttering is the verbal manifestation of Central Language Imbalance which affect all channels of communication; reading, writing, rhythm and music 
    • Stuttering; speech only 
    • Cluttering; language disorder 
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Helping those with fluency problems

  • No known cure 
    • Have to help them to cope 
    • Calm anxieties about speech, adapt to abilities, increase quality of life 
  • Fluency problems can be helped with therapy programmes
    • More readily available for adults 
  • Language Awareness Exercises 
  • Prevention
  • Children 
    • Introduce good linguistic model
    • Reduce communicative pressure 
    • Keep them rested and healthy 
    • Seek professional help if needed
    • Empower them in other ways 
    • Not pressurise them 
  • Adult 
    • Psychotherapy
      • See counsellor and work through insecurities 
    • Work with delayed auditory mechanism 
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Voice Disorders

  • Disorders of phonation arise when something interferes with the functioning of the larynx 
    • Hoarse or breathiness
  • Disorders of resonance arise when something interferes with the functioning of the adjoining cavities (upper airway) so that the abnormal timbres are introduced (nasal voice) 
  • These difficulties are often caused through contact or abuse and can normally be treated by rest, therapy, drugs and/or surgery 
  • Disorders of Phonation 
    • Dysphonia 
      • Persistent huskiness, hoarseness, harshness, breathiness and vocal inefficiency 
  • Causes 
    • Faulty use of the voice: no demonstrable disease or structural disorder 
    • Traumatic laryngitis: rest 
    • Vocal fold thickening: voice therapy 
    • Vocal nodules and polyps: voice therapy 
    • Laryngeal trauma
    • Neurological or sstemis disorder: radiotherapy or laryngectomy 
    • Psychological problems: anxiety 
    • Hormone problems: puberphonia - boys voices dont break + androphonia - girls voice do break
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Management of Voice Disorders

  • Voice therapy 
  • Laryngectomy
    • Larynx removed and replaced with artificial substitute 
    • New voice source 
    • Esophageal voice 
  • Voice screening 
    • Collect vioce samples
    • Consider control groups
      • How they typically speak
    • Address causes
      • Current voice use/misuse
    • Where is the problem?
    • Why could it be happening?
    • Respiratory performance
  • Voice problems help
    • Rest voice
    • Medication
    • Voice therapy/psychotherapy
    • Surgery eg if nodules are cancerous 
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Articulation Disorders

  • An individual may possess a completely misarticulated sound system so that the person is largely unintelligible or the individual may just experience difficulty with a particular sound 
  • Problems may be caused by mis-aligned teeth, cleft lip and/or partial paralysis of the vocal tract associated with conditions such as Parkinson's Disease and Dysarthria
  • Problems may be helped by speech therapy, drugs and/or surgical intervention 
  • Cleft Palate
    • 1 in 750 live births 
    • What is it? 
      • A cleft is an elongated opening originated in the very early stages of pre-natal development 
    • Vocal apparatus is primarily involved 
    • Person has a congenital fissure in the middle of the palate which may extend throughout the whole palate or effect the uvula and/or soft palate 
    • Twice as frequent in males than females 
  • Cleft Lip 
    • Upper lip is split and often includes the whole of the alveolar process 
    • Problems occur in the womb during the process of early formation 
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Cleft Palate

  • Cause
    • Multifactorial aetiology 
  • Associated difficulties 
    • Feeding problems 
    • Middle ear infection 
    • Psycho social problems 
    • Language development will be at a slower rate 
    • Nasalisation 
      • Incorrect air flow 
      • Articulations involving lips and palate will fail 
    • Sloppy sounds 
    • Connected speech is difficult to follow
    • Phonation disturbances 
      • Husky voice 
    • Infection may lead to hearing difficulties 
    • Early surgery can eliminate many of these problems 
      • Intervention recommended for infants in first year of their life
      • Early Language Programmes, Parent Counselling, good success in reconstructions, few have long term problems 
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  • What? 
    • Specific reading disability due to a defect in the brains processing of graphic symbols 
    • It is a learning difficulty that alters the way the brain processes written material and is typically characterised by difficulties in word recognition, spelling and decoding 
  • Pathways to Reading 
    • Direct Route: visual route, ready by eye; most effective 
      • Dissect shape, recognise it and read without meaning 
      • DIssect shape, recognise it and read with meaning
    • Indirect Route: phonological route, read by ear
      • Recognise shape, break it down into letters 
      • Sounds access meaning and read 
    • We use both routes 
    • If something goes wrong, likely dyslexia 
    • More you read = larger visual store 
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Acquired Dyslexia

  • Peripheral Dyslexia 
    • Problems with the visual analysis system 
      • Neglect Dyslexia 
      • Visually based Dyslexia 
      • Approximate visual access
      • Letter by Letter Dyslexia
  • Central Dyslexia 
    • Problem with one/some of the routes 
    • A difficulty with words 
  • Where the difficulty is affects the type of Dyslexia 
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Reading without meaning

  • Damage to the semantic system
  • Only ready surface level
  • No activation of semantics
  • Person can read words 
  • Person can read words but not understand what is read
  • Makes no different whether the word is regular or irregular 
  • Cant form logical groups from lists of words 
  • Semantic representation isnt activated 
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Dyslexia 2

  • Surface Dyslexia 
    • Cant use visual route 
    • Spell out - phonic mediation
    • Regular words are read more accurately than irregular words 
      • Mispronunciation errors 
    • Sounds activate meaning
  • Phonological Dyslexia 
    • Cant use phonic route 
    • Read by sight so can only read known words 
    • Reading store is intact 
    • Make visual mistakes 
    • Less disabling for the adult reader than surface dyslexia 
  • Deep Dyslexia 
    • Everything in one
    • Reading without meaning/visual/phonic route 
    • Left hemisohere for reading has been destroyed; any reading takes place via the right hemisphere 
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Dyslexia 3

  • Developmental Dyslexia 
    • Difficulties with accurate and/or fluent word recognition and spelling despite adequate instruction and intelligence and intact sensory abilities 
    • Same range of conditions 
    • More common in boys
    • Early detection is important 
    • Must be typical in all except reading and writing 
    • Typical cognitive abilities 
    • Extreme difficulties in learning to read and write 
  • Recognising Dyslexia 
    • Under 5 
      • Delay in initial speech development 
      • Rambling speech, difficulty with sentences 
      • Clumsiness, pen control
      • Unusual laterality 
      • Lack of control 
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Dyslexia 4

  • Recognising Dyslexia 
    • Two years onwards
      • Problems with puttnig things in order 
      • Sequencing issues 
      • Problems with memory tasks - digit recall 
      • School related problems 
        • Poor reading and writing compared with verbal skills 
        • Messy work, slow, lots of crossing out 
      • More slips of the tongue 
      • Slower with some interpretation 
  • Dyslexia diagnosed 
    • Literacy ability is 2 years behind age 
    • Other areas of development are age appropriate
    • Cause 
      • No 1 unitary cause 
      • General neurological weakness for left hemisphere activity 
      • Genetics 
      • Differing neural pathways 
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Developmental Dyslexia

  • Same range of difficulty as acquired dyslexia 
  • Much greater variation 
  • Acquired 
    • Consistent errors 
    • Trauma, damage 
  • Developmental 
    • More variation
    • No brain damage 
    • More scope for intervention 
  • Dominantly surface or phonological dyslexia 
    • Not pure 
    • Elements of both
  • Spelling
    • Cant guess 
    • More problematic than reading
    • Same range of spelling errors as reading errors 
    • Some spelt as said, some spelt as thought should look 
    • Children will respond with carefully designed programmes which start with attainment and progress 
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