Phonological Assessment Remediation- CDS 3100

1. Phonological Assessment & Remediation- CDS 3100 Dr. Gail J. Richard cfgjr@eiu.edu 2213 Human Services 581-2712 Office Hours: M � R 1:00-2:00 or by appt GA: Emily Frailey - 2204

2. Course Objectives Students will review general anatomy, physiology, and definitions in relation to phonological production and development. Students will be able to discuss pertinent phonological diagnostic factors and disorders. Students will demonstrate basic competence in traditional articulation and phonological assessment instruments and intervention approaches.

3. Departmental Learning Objectives Describe characteristics and etiologies of normal and disorders phono/artic Demonstrate knowledge & skills to assess articulation /phonology Demonstrate knowledge & skills related to prevention and intervention of phonological/articulation disorders Engage in professional oral communication and interaction Design, select, administer and interpret formal evaluation tests Compile evaluation data to generate appropriate diagnosis, recommendations, and referrals Select and utilize case appropriate materials during intervention

4. Unit I - Phonological DevelopmentChapters 1, 2, 3, 10 Anatomy & Physiology Review Vowel & Consonant Production 1. Traditional Sound Classes 2. Distinctive Feature Classification 3. Phonological Rules & Processes Phonological Developmental Norms 1. Traditional Articulation Norms 2. Phonological Process Norms Factors Correlated with Phonological Disorders 1. Functional Problems 2. Organic Disorders

5. Unit II - Phonological Assessment Chapter 4, Hodson 1, 2, 3, 4 Assessment Goals & Options Traditional Articulation Assessment Procedures Goldman-Fristoe Test of Articulation Fischer-Logemann Test of Articulation Competence McDonald Deep Test Related Procedures Case History Oral Peripheral Examination Auditory Acuity & Discrimination

6. Unit II - continued Phonological Assessment Procedures Phonological process Analysis- Weiner Natural Process Analysis- Shriberg & Kwiatkowski Procedures of Phonological Analysis- Ingram Hodson Assessment of Phonological Patterns � HAPP-3 Khan-Lewis Phonological Analysis Severity Ratings and Utilization of Assessment Results

7. Unit III - Phonological RemediationChapters 5, 12, Hodson 5, 6, 7, 8 Remediation Goals Traditional Articulation Therapy- Van Riper Phonological Process Remediation- Hodson & Paden Other Approach Options

8. Course Requirements Attendance in class will be critical for successful comprehension and completion of the course, however it will not be formally recorded. If you have a documented disability and wish to discuss academic accommodations, please contact the Office of Disability Services.

9. Grades Grades will be based on a percentage of 400 points. A 90-100% 360-400 pts. B 80- 89% 320-359 pts. C 70- 79% 280-319 pts. D 60- 69% 240-279 pts. F Below 60% 0-239 pts.

10. Point Accumulation Exam I: Phonological Development 100 pts. Exam II: Phonological Assessment 100 pts. Exam III: Phonological Remediation 150 pts. Projects: Assessment Scoring 50 pts. Total = 400 pts.

11. Assignments Exam I: approximately 9/15 Exam II: approximately 10/27 Exam III: final exam time 12/12 � 8:00 Projects TBA 1. Score Goldman-Fristoe 10 pts. 2. Score HAPP-3 15 pts. 3. Score HAPP-3 15 pts. 4. In class Rx session 10 pts.

12. Packet of Test Protocols Test forms for Language Disorders & Phonological Disorders are available for purchase. This includes tests for CDS 3200 & CDS 3700.

13. INTRODUCTORY COMMENTS The Communication System

14. Speech Basic to Communication Transfer endless thoughts and ideas Artic most prevalent type of speech disorder 10% of population - communication deficit 75% are articulation deficits 2% of school aged population has artic deficits

15. The Communication System:Information flow between two people RECEPTION - Sensation - Perception - Conceptualization - Cognition EXPRESSION - Ideation - Codification - Code Retrieval - Neuromotor Patterning - Production

16. Other Factors Affect & motivation Attention Feedback Memory Relationship

17. DEFINITIONS

18. Articulation Process of producing and using speech sounds of one�s linguistic community (Bankson & Berenthal) The utterance of individual speech sounds (Van Riper)

19. Articulation Disorder Sounds consistently produced at variance with cultural and age norms (Bankson & Berenthal)

20. Errors in Speech Production Omission deletion of expected sounds from words affects intelligibility the most frequent in deaf / hard-of-hearing Substitution replacing one sound with another most common error Distortion: off target approximation Addition: add extra sound; infrequent

21. Causes of Disorder Organic - related to structural deformity , physical defect, or neuromotor functioning Functional faulty learning no obvious etiology associated with sensory, structural, or neurological deficits

22. Current Approach - Linguistic Phonology: study of sound system of the language - systematic pattern to errors segments (speech sounds) suprasegments (stress, intonation, pauses Motor Speech: motor movements required to produce specific speech sounds movements of tongue, lips, etc. organic production aspect

23. Must Consider both Articulation & Phonological Aspects of Speech Articulation: actual mouthing or sound production process Phonetic Errors: motor-based errors; ability to produce sound not in individual�s capability Phonology: rule system governing correct use of sounds Phonemic Errors: not aware of rules to use sounds but able to produce them; linguistic problem

24. Speech Production =  Inter-related Anatomy & physiology Phonological rules Delayed versus Deviant Normal development & behavior

25. Effective Remediation Based on Accuracy of Diagnostic Assessment Many alternatives; must know different strategies and individual client

26. Assignment for Thursday Read first two chapters in text Bring text to class - will begin anatomy review and sound classification; text will help! Review Intro, Anatomy/Physiology, and Phono Dev. notes

27. Questions ?

28. Speech is a Vehicle to Convey Language

29. LANGUAGE Semantics: word meanings Syntax: grammatical rules Morphology: units of meaning Pragmatics: social context rules Phonology: linguistic rules governing sound system

30. PHONOLOGY: study of linguistic rules governing the sound system of language Phonetics: individual speech sounds Articulation: motor action of organs of speech to produce sounds Phonemic Transcription: phonemes Phonemes: minimal sound units representing language Phonetic Transcriptions: sensitive to sound variations within phoneme class (allophones)

31. SPEECH MECHANISM Respiratory System Larynx Velopharynx Articulators Jaw Central Nervous System

32. Speech Mechanism

33. Respiratory System Structures: 1. lungs 2. airway 3. rib cage 4. diaphragm Function: generate air and push into airway to generate sound

34. Larynx Structures: various cartilages & muscles Functions: 1. Generates voiced sounds by vibration of vocal folds 2. Allows air to pass from lungs to vocal tract for voiceless sounds

35. NORMAL VOCAL CORDS

36. NORMAL VOCAL CORDS

38. Velopharynx Structures: soft palate & associated structures Functions: 1. Joins or separates oral and nasal cavities 2. Allows air to pass through oral, nasal, or both cavities

39. Articulators: complex of muscles Structures: 1. tongue tip/apex back/dorsum body blade root 2. lips 3. jaw 4. velopharynx Functions: Shortens, lengthens, and constricts vocal tract

41. Functions of the Jaw and Tongue Tongue: 1. Principle articulator of the oral cavity 2. Assumes variety of shapes & positions for consonants and vowels Jaw: 1. Supports soft tissue of tongue & lower lip 2. Skeletal support- aids tongue & lip movements

42. Central Nervous System Controls all speech mechanism systems Translates messages into pattern of signals for speech muscles Millisecond timing for muscle contraction and coordination from respiration on

43. Vowel Articulation Produced as sound energy from vibrating vocal folds Produced with relatively open vocal tract Syllable must contain vowel or vowel-like sound; forms nucleus of syllable Each vowel has vocal tract shape determined by position of tongue, jaw, lips, and pharynx

44. Vowels - Positions

45. Cardinal Vowel Diagram

47. Dipthongs Shift in resonance and vowel quality during production articulation gradually changes during production progressive change in vocal tract shape

48. Consonant Articulation

49. Consonants � Place of Production

50. Consonants- Manner of Production

51. Stop-plosive Oral cavity is sealed, causing a build-up of oral air pressure, which is released suddenly Two structures block passage of air, building up pressure behind the closure /p,b/ - bilabial /t,d/ - alveolar /k,g/ - linguavelar

52. Fricatives Narrow constriction formed in oral cavity; air creates friction noise as it moves through the passageway /f, v/ - labiodental �th� � linguadental /s, z/ -lingualveolar �sh, zh� - linguapalatal

53. Affricates Combine plosive and fricative characteristics; period of partial closure followed by brief fricative release linguapalatal

54. Nasal Lower the velum to use nasal pharynx in production; sound energy through the nose /m/ - bilabial /n/ - alveolar �ng� - velar

55. Glides & Liquids Glides / j / - palatal / w / -bilabial Liquids / l / -alveolar / r / - palatal

56. Classification of Consonant Phonemes

57. Consonants - Voicing

58. Dynamics of Speech Production Coarticulation: two articulators are moving simultaneously to produce two different phones; causes modifications in movement influenced by phone preceding or following adaptation - variation in way articulators move assimilation - change enough to take on the characteristics of neighboring sound

59. DISTINCTIVE FEATURES Definition: articulatory or acoustic parameter whose presence or absence defines a phoneme

60. Markedness Theory Account for finer details within distinctive feature system plus value is marked value and makes sound more difficult

62. Phonological Rules Describe sound system of a language some universals across all languages phonemes of language allophones of phonemes & conditions for appearance allowable word positions and phoneme combinations

63. The Phoneme Smallest unit of sound capable of affecting meaning set of phonemes combined to form words phoneme set consists of vowels and consonants of the language larger set gives more flexibility smaller set easier to articulate & discriminate English has 46, large set (smallest is 5)

64. Allophone Variant of phoneme category (aspiration) different phones, but same phoneme, same meaning phoneme in slashed - broad transcription allophone in brackets - narrow transcription keep coop man bat ten tenth

65. Questions

66. Phonological Rules Describe allowable structures and sound combinations of a given language

67. Morphophonemics Morpheme: smallest unit of meaning bound morphemes - must be attached to another morpheme free morphemes - have meaning by themselves Morphophonemic Rules govern production of sounds in combinations of morphemes; relate phonological and syntactic rules

68. Suprasegmentals segmentals- units involved in description are size of phonemes or phonetic symbols suprasegmentals- characteristic of speech that involves larger units (prosodic features) Most suprasegmental information described by physical qualities of speech amplitude/intensity - perceptual loudness duration - perceptual length fundamental frequency - pitch

69. Suprasegmentals stress- degree of effort, prominence, or importance given to part of an utterance intonation- vocal pitch contour of utterance; way fundamental frequency changes loudness- sound intensity; amount of vocal effort speaker uses pitch level- average pitch of speaker�s voice juncture- vocal punctuation; pauses speaking rate- words, syllables, or phonemes per second

70. Review of Development

71. Theories of Normal Development

72. Speech Development Stage: Newborn Age: 0-1 mo Speech: Reflexive utterance; Suck-swallow pattern; Nondifferentiated crying; Vegetative sounds with phonation, but incomplete resonance Other: 6-8 lbs. & 21�; Can�t raise head when on stomach; Visual & auditory preferences; Sensitive to volume, pitch and duration of sound; Sleeps 70%

73. SPEECH DEVELOPMENT Age: 2-3 mos. Stage: Cooing (comfort sounds) Speech: Definite start & start to oral movement; Velar to uvular closure or near closure; Back consonants & back and middle vowels with resonance Other: Holds head up briefly while on stomach or sitting supported; Repeats own actions; Visually searches; Begins exploratory play; Excited by people; Social smile

74. Speech Development Age: 4-6 mos. Stage: Babbling Speech: Greater independent control of tongue; Prolonged strings of sounds; More lip or labial sounds; Experiments with sounds Other: 12-16 lbs. & 23-24�; turns head to localize sound; Mouths objects; Sits supported for .5 hour; Selective Attention to faces; Anticipates actions; Excites with game play

75. Speech Development Age: 6-10 mos. Stage: Reduplication babbling (socialized) Speech: Repetitive syllable production; Increased lip control; Labial and alveolar plosives /p,b,t,d/, nasals, /j/, but not fully formed Other: Self-feeding; Progresses from creeping through crawling to standing; Explores objects through manipulation; Imitates others physically; Gestures

76. Speech Development Age: 11-14 mos. (11-12 mos.= vocal play & 12-14 mos.= first true words) Stage: Vocables and first words Speech: Elevates tongue tip; Variegated babbling; Intonational patterns; Vocables- sound- meaning relationships; Predominance of /m,w,b,p/; First words primarily CV, VC, CVCV reduplicated, and CVCV Other: 26-30 lbs & 28-30�; Stands alone; Feeds self with spoon; First steps; Uses trial and error problem-solving; Deferred irritation

77. Speech Development Age: 2 years Speech: Has acquired /p,h,w,m,b,k,g/ Other: 31-35 lbs. & 32-34�; Walks without watching feet; Limited role playing; Parallel play; Short incomplete sentences; 200-300 word vocabulary

78. Speech Development Age: 3 years Speech: Has acquired vowels Other: Short incomplete; Explores by dismantling; Rides tricycle; Representational drawing; Make- believe play; Shares toys briefly; subject and verb sentences; 900- 1000 word vocabulary

79. Speech Development Age: 4 years Speech: Acquired Other: Walks stairs with alternating steps; Categorizes; Counts to five; Role plays; Cooperative play; Tells stories; Asks many questions; 1500-1600 word vocabulary

80. Speech Development Age: 5 years Speech: Acquired Other: 41-45 lbs. & 40-42�; Prints simple words; Time concepts of recent, past, and future; simple game playing; 2100-2200 word vocabulary; Syntactic acquisition about 90% complete

81. Acquisition of Speech Sounds

84. Profile of Phonological Development

85. Development of Meaningful Speech Phoneme development not always nice progression progressive and regressive idiosyncratic patterns progress from pre-linguistic to linguistic stage - when use phonetic productions meaningfully

86. Group Studies on Speech Sound Development (1yr plus)

87. Group studies cont.

88. Speech sound development - Consensus of Research Studies

89. Natural Processes: occur developmentally in normal children across languages Final consonant deletion Velar fronting Stopping Palatal fronting Liquid simplification Assimilation Cluster reduction Unstressed syllable deletion

90. Simplification Processes: simplify sound sequences by omitting or modifying phonemes Omission Assimilation progressive regressive Vowel Reduction Syllable Reduction

91. Phonological Processes

92. Syllable Structure/Shape Processes

93. Assimilation Processes

94. Substitution Processes

95. Voicing Processes

96. Other Phonological Processes Epenthesis Metathesis affrication / deaffrication palatalization / depalatalization glottal replacement

97. Phonological Process Suppression Text p. 59 Hodson / Paden � age 4-5

99. Must interpret Norms Cautiously Based on averages of large numbers of children don�t reflect individual child must allow for individual differences Provide good baseline to evaluate general development

100. Using Developmental Norms Advantages Disadvantages

101. Speech Perception Ability to discriminate perceptual features of phonemes In general - perceptual ability precedes production Relationship between debated

102. Children�s phonological errors are systematic; May appear to be random but governed by series of phonological rules

103. Ingram�s Conclusions - Children with Phonological Disorders Use many of the same phonological processes as normal; also use idiosyncratic processes - unusual by normal standards Persist in use of infantile processes - so co-occur with later developing processes Exhibit greater number of phonological processes; more inconsistent in usage than normal Vary in processes that persist Exhibit disorder of phonological component of lang.

104. Factors Related to Articulatory Disorders Age Intelligence Gender Personality / Adjustment Language Development Socioeconomic Status Linguistic Variation & Cultural Influences

105. SUMMARY Learning phonological system of a language is rule governed Several theories to explain developmental process Children follow similar sequence of development, although ages of actual acquisition may differ Great deal of learning for speech/sound production during first year , prior to any intelligible speech

106. SUMMARY General expectations first words - age one year intelligible - 3 years near-perfect articulation - start of school; age 5 years/kindergarten Information re: normal development imperative to understand and design effective remediation

107. Organic Problems

108. Organic Disorders Disorders that arise from physical anomalies affecting structure or function of the speech mechanism. Damage may be due to structures of oral mechanism or central/peripheral nervous system

109. Etiology = Different Considerations Organic doesn�t imply single disorder Treatment often multidisciplinary; other things affected Prognosis has direct relationship to degree of organic involvement Work toward realizing potential for communication versus maximum potential Therapy plan must be realistic Counseling component

110. Structural Anomalies - congenital or acquired Lips Tongue glossectomy Palate Velum / Soft Palate Velopharyngeal Incompetency Nasopharynx Tonsils & Adenoids

111. Organic Disorders Apraxia Dysarthria Cerebral Palsy Cleft Palate Hearing Loss

112. Organic Disorders Definition Etiology Speech Characteristics Associated problems Assessment Prognosis Remediation

113. APRAXIA Definition: sensory motor speech disorder; an impairment of central motor programming for voluntary production of phonemes, as well as a sequence of phonemes Etiology: insult to the brain

114. APRAXIA Associated features: aphasia physical, emotional, or psychological problems that accompany stroke

115. Apraxia Speech characteristics: (oral apraxia) struggle with speech errors are inconsistent consonants are harder than vowels to program errors increase as motor complexity > short utterances are easier to program

116. Apraxia Assessment: check all structures vowel VS consonant production repeat multisyllabic sequences or diodochokinetic rates

117. Apraxia Prognosis: correlates with aphasia; depends on age, health, motivation more awareness=self-correction Remediation: regain voluntary control over articulation direct therapy with motor repetition & phonetic placement by drill, model, & mirror

118. DYSARTHRIA Definition: disorder in speech mechanism that affects phonation, articulation, resonation, respiration, & prosody (suprasegmentals); occurs as a result of weakness, incoordination, & paresis in speech muscles

119. DYSARTHRIA Etiology: stroke neurological degenerative disease head trauma toxic conditions cerebral infection

120. Dysarthria Speech characteristics: errors will be consistent because programming is the same phonation resonation respiration articulation prosody

121. Dysarthria Associated problems: general gait balance fine and gross motor coordination Assessment: structural - size, proximity, structure functional - movement, range, speed, & strength

122. Dysarthria Prognosis: severe dysarthria- realistic goals interdisciplinary may not reach normal speech; compensatory

123. Dysarthria Remediation: 5 processes of speech compensation for speech development structured & repetitive practice drills practice programming exercises to strengthen

124. CEREBRAL PALSY Definition: spectrum or syndrome disability; abnormal motor function; cognitive & sensory deficits

125. CEREBRAL PALSY Etiology: damage or malformation of the brain prenatal- drug abuse by mom, infection, anoxia, or hemorrhage paranatal- anoxia, forceps, drugs during delivery postnatal- head trauma, anoxia, infection

126. Cerebral Palsy Associated problems: general ambulation self care difficulty sucking, eating, swallowing vision ( 50%) & hearing ( 20%) cognitive/mental retardation ( 75%) speech & language ( 70%) psychological or emotional problems; especially those with an intact IQ

127. Cerebral Palsy Speech characteristics: articulation- dysarthria phonation- harsh, rough, weak voice resonation- can�t control velum to direct air language- consistent with cognition

128. Cerebral Palsy Assessment: inhibit extraneous movement /reflexes swallowing pre-speech evaluation- muscle control Prognosis: consistent with degree of impairment

129. Cerebral Palsy Early Remediation: pre-speech train parent to hold child in order to stimulate muscles, feed, & model babble exercise to strengthen normal muscles work with all systems augmentative alternative goals

130. CLEFT PALATE Definition: structural deficit in the tissue or muscle of lips, alveolar ridge, hard palate, & soft palate; occurs in 1st trimester of pregnancy because of failure of growth or failure of union

131. CLEFT PALATE Etiology: Environmental causes Blockage Genetic Acquired

132. Cleft Palate Speech Characteristics: A. Resonance soft palate hard palate vowels consonants hyponasality B. Articulation C. Dental D. Hearing loss E. Phonation

133. Cleft Palate Associated Problems: feeding - leaks out nose medical - hearing, visual, heart IQ- trauma or environmental influences psychological - experiences medical procedures

134. Cleft Palate Assessment: Oral-Facial exam Prognosis: 95% accomplish normal speech Remediation: primary- surgery or prosthetic secondary- direct muscle training or indirect muscle training

135. HEARING LOSS Definition: 1. conductive- outer or middle ear 2. sensory-neural- inner ear Degrees of loss: - mild - slight - moderate - severe

136. Hearing Loss Speech Characteristics: 1. Vowels - neutralization - nasalization dipthongization - prolongation - substitution 2. Consonants - voicing - final consonant deletion - initial substitution - nasal emission

137. Hearing Loss Variables Impacting Speech: Age of onset Level of hearing acuity Speech discrimination Configuration of hearing loss

138. End of Unit I Exam Tuesday, September 20

139. Exam Format Multiple Choice Definitions Listing Matching Fill in Blank Short Answer Labeling Diagrams

140. Review

141. Cause of Disorder Organic: related to structural deformity or physical deficit Functional: faulty learning; everything appears normal; not etiologically associated with known or obvious sensory, structural, or neuromotor deficits

142. DEFINITION Articulation: Process of producing and using speech sounds of one�s linguistic community Articulation Disorder: Sounds consistently produced at variance with cultural or age norms

143. PHONOLOGY / ARTICULATION Articulation actual mouthing motor production of individual speech sounds Phonetic Errors motoric based errors; inability to produce speech sound Phonology sound system of language rule system governing correct use of sounds Phonemic Errors linguistic/phonological error; rule to use sound

144. Errors in Speech Production Omission: deletion of expected sounds from words; affects intelligibility the most Substitution: replacing one sound for another; most frequent type of error Distortion: off- target approximations of sound Addition: insert extra sound; infrequent

145. SPEECH MECHANISM Respiratory System Larynx Velopharynx Articulators Jaw Central Nervous System

146. Vowels - Positions

147. Dipthongs Shift in resonance and vowel quality during production articulation gradually changes during production progressive change in vocal tract shape

148. Consonant Articulation

149. Phonological Processes Modifications of speech sound production away from the standard adult production; used to simplify production

150. Simplification Processes Syllable Structure Processes Assimilation Processes Substitution Processes Examples of each?

151. Know the Following Definitions Communication System � Receptive/Expressive Speech Mechanism � six systems & function Types of articulation errors & examples Consonant definitions Simplification Processes & examples Correlated Factors Advantages/Disadvantages of norms Functional versus organic disorders Characteristics of organic disorders

153. Purpose of Assessment Evaluate nature of disorder by sampling, analyzing, and specifying characteristics describe phonetic proficiency of individual determine if sound system deviates from norm determine direction, form, frequency of Rx Observe changes due to remediation or maturation Screen Make prognostic statements

154. Phono/ Artic Domain of SLP Formal Tests Sample Conversation Stimulability Nature of individual error pattern - phono or artic Consistency of errors Intervention or not

155. Assessment Procedures

156. SCREENING Purpose identify person who may need remediation brief and simple procedure determine if further testing needed Instruments 5 minutes or less small but representative sample formal and informal options

157. Picture Inventories More comprehensive, more time required Child names picture, object, event Target sound in word in specific position initial, medial, final word context pre, inter, post vocalic syllable context

158. Picture Inventories Advantages efficient & easy can use standardized norm comparisons many available on market pictures of greater interest to children Disadvantages single word may not reflect spontaneous speech can�t evaluate coarticulation single utterance for target sound if can�t elicit - named imitation better not representative

159. Reading Word Lists / Sentences

160. Conversational Sampling better idea of intelligibility & consistency heavier weight in therapy determination goal is spontaneous speech, not words Methods Person may screen words; not accurate representation time constraints can�t sample all sounds if intelligibility poor, trouble transcribing

161. Stimulability Testing how easily child modify error on imitation ability to repeat correct form of target provide auditory, visual model use for prognostic purposes correct on own ease of correction in remediation prediction for remediation success high stim stim in isolation priority for remediation

162. Contextual Testing Influence of surrounding phones on sound provide phonetic context to determine direction of remediation measure consistency of errors determine contexts where produced correctly determine facilitative context for therapy Methods - spontaneous or deep test Time consuming - only do for key concerns

163. Related Procedures Case History Oral Peripheral Evaluation Audiological Assessment Auditory Discrimination

164. Case History Possible etiological factors family / client perceptions academic, home, school, work environment and pressures medical, developmental, and social information

165. Oral Peripheral Exam Purpose Facial Characteristics Dentition Hard Palate Soft Palate / Velum Pharynx Tongue

166. Purpose - Oral Peripheral Exam Assess structures & function of oral mechanism for speech intact vs. potential problems organic vs. functional

167. Facial Characteristics Symmetry expression general health size, shape

168. Dentition Overall dental health jaw alignment - occlusions structural deviations dental appliances supernumerary teeth

169. Hard Palate Color - pink or white clefts or fistulas size and height of vault feel

170. Soft Palate - Velum Color length - size and shape function clefts or scar tissue

171. Pharynx: faucial pillars, tonsils, adenoids Presence / absence color, size resonance characteristics length and mobility of palate / uvula

172. Tongue Appearance and size - micro-macroglossia position of tongue in mouth at rest lingual frenum protrusion, movement, strength, coordination tongue exercises for movement independence of other structures strength - tongue depressor coordination - diodochokinetic rates Appendix 4.3

173. Diadochokinetic Syllable Rate

174. Audiological Assessment Pure tone screening Impedance eardrum compliance middle ear pressure acoustic reflex Fail - refer for complete audiological eval.

175. Auditory Discrimination Purpose: ability to distinguish between speech sounds often considered prerequisite to production discrim of correct form of error sound very important Formal tests and informal procedures

176. Scoring Procedures Varies according to test purpose, personal preference, and transcription skills Correct / Incorrect (screening) Classify errors Distortion - D or more precise if possible Substitution - error/target Omission - minus sign Addition - represent actual sounds

177. Scoring Procedures - Comments Some classify same error differently e.g., glottal stop at end of word = substitution or omission numerical count of errors = index of severity IPA is transcription system broad transcription usually acceptable diacritical markers / narrow helpful Reliability of Scoring - experience w/ test

178. Analysis Procedures Overall intelligibility First judgement made by clinician More unintelligible, greater need for intervention rate on continuum of intelligibility

179. INTELLIGIBILITY FACTORS Number of different sounds produced in error Consistency of misarticulated sounds Frequency of target sound in language Similarity of error to target Suprasegmentals

180. SOUND-BY-SOUND ANALYSES Stimulability Consistency of errors Context of errors Syntactic level of errors Ease of production Frequency of occurrence Age of acquisition

181. TREATMENT DECISION Based on articulation sample Test Battery results overall intelligibility age comparison norms stimulability consistency nature of error patterns Linguistic culture Attitude of client / parents

182. Criteria for Test Selection Sample obtained Material presentation style Scoring & analysis consonant / vowel place, manner, voicing phonetic contexts phonological processes comparison norms

183. Goldman-Fristoe Test of Articulation Sample obtained: 34 color picture plates; 63 target words single word naming response samples 61 consonants, 16 consonant clusters 3 subtests: Sounds in words � spontaneous single word Sounds in sentences �conversational speech Stimulability �correct error with model Material presentation: familiar items notebook that stands up

184. Goldman-Fristoe Test of Articulation Scoring and analyses: color coded to position of word recording form follows acquisition order n Standards score Discussion: attractive quick; 5-15 minutes 3 samples 2-21 years

185. Recording on Goldman-Fristoe Sound correct � leave blank Sound in error Substitution � write IPA symbol in cell Omission � mark cell with dash (-) Distortion � write 2 for mild; 3 for severe Addition � write additional plus correct Narrow transcription recommended Nasalization (~) Dentalization Lateralization Prolongation Aspiration Glottal Stop

186. Recording Stimulability Testing for error sounds starts at syllable level With success, progresses to word and sentence Single stimulability Success � check mark in cell Failure � X in cell Multiple model � success: check mark next to X

187. Determining Standardization Raw Score: count all errors in grid, including consonant clusters Record raw score � range 0-77 Charts to determine standard score, percentile, age equivalency Percentile may be more appropriate way to represent abilities for comparison to peers than standard score

188. Fischer-Logemann Test of Articulation Competence Sample obtained: 35 picture plates 25 consonants and 22 clusters, vowels, and diphthongs test pre, inter, post vocalic contexts also has screening section Material presentation: color pictures spiral easel

189. Fischer-Logemann Test of Articulation Competence Scoring analyses: recommend narrow transcription in manual pattern analyses by place, manner, and voicing vowels by tongue height, place of artic, tension and lip rounding Discussion: 10-12 minute administration time organization of scoring analyses narrow transcription takes preparation

190. McDonald Deep Test of Articulation Sample obtained: collection of sound specific measures sounds in number of phonetic contexts observe effect of phonetic context on production of sound segments alter preceding and following contexts systematically

191. McDonald Deep Test of Articulation Material presentation: pair of colored pictures -monosyllabic meant to be produced as bisyllabics sentence alternative provided (3rd grade reading) screening deep test also 60 items for each target- 5-10 minutes Scoring and analysis: correct or incorrect no normative data

192. Other Articulation Tests Arizona Articulation Proficiency Scale Photo Articulation Test Templin-Darley Test of Articulation Bankson-Bernthal Test of Phonology

193. Phonological Analysis Pattern Analysis discover organization to child�s errors look at relationship between sounds & language use with fairly unintelligible individuals; more global problems Place, Manner, Voicing - look for similarities voiced for voiceless stops for fricatives alveolar for velar back sounds for front sounds

194. Obtaining a Sample Examine child�s habitual rules system single words - Hodson & Paden phrases - Weiner conversation - Shriberg & Kwiatkowski Sample should reflect production in actual communication situations reveal both consistencies & inconsistencies contain full set of English phonemes

195. Concerns Regarding Sample Imitated productions /single words may not reflect spontaneous Problems transcribing if unintelligible Recording - Tape/ and or video miss acoustic and visual cues; also contexts do as much spontaneous as possible Phonetic Transcription be careful not to �fill in� what is missing be careful not to apply meaning to unintelligible words transcribe as close as possible

196. Phonological Processes Definition: Simplification of adult phonological patterns Variations in specific processes analyzed Authors subdivide major processes differently Authors define same processes differently

197. Major Processes in Common Syllable reduction Cluster reduction Stopping - stop for fricative Fronting - anterior to normal placement Final consonant deletion Assimilation Liquid Simplification

198. Definition Variations Cluster Reduction Weiner - marked (most difficult) member deleted Hodson - one or more consonant members in cluster deleted Ingram - deletion of one or more consonants that occur together within same syllable Fronting Weiner - sounds produced anterior to normal place of production Hodson - velars /k,g,ng/ come forward Ingram - movement of tongue from palatal or velar area to alveolar area

199. Phonological Assessment Instruments

200. Hodson Assessment of Phonological Patterns Barbara Hodson HAPP-3

201. Designed to Assess and categorize phonological deviations Provide treatment direction for children with highly unintelligible speech Yield post-treatment data for evidence �based practice documentation Standardized Norm-referenced Criterion-referenced

202. Five Forms Comprehensive Phonological Evaluation Record Form Major Phonological Deviations Analysis Form Substitutions and Other Strategies Analysis Form Preschool Phonological Screening Record Form Multi-syllabic Word Screening Record Form

203. Purpose � HAPP-3 To analyze phonological deviations of children with highly unintelligible speech Can be used with preschool and older children. Looks at underlying language rules � not motor production; when to use phonemes and how to put them together in sequences Three components

204. First Component � HAPP-3 Comprehensive Phonological Evaluation Stimulus objects and picture cards Elicit spontaneous production of 50 words Administration time of maximum 20 minutes Results � presence of and level of severity of phonological impairment Provides direction for planning treatment Ongoing scores serve at outcome measures

205. Second Component � HAPP-3 Preschool Phonological Screening Quickly identify children who warrant a comprehensive evaluation 12 words Requires approximately 2 minutes to administer Can be used as young as 2 years of age

206. Third Component � HAPP-3 Multisyllabic Word Screening Assess children older than 8 yrs of age with difficulty pronouncing multisyllabic words 12 words from picture stimulation Approximately 2 minutes to administer

207. Format - HAPP-3 48 stimulus items to elicit 50 target words in response to objects and pictures Monosyllabic and polysyllabic words All English consonants included Most English vowels and dipthongs included Items chosen to represent words familiar to English-speaking preschool children Objective, standardized, norm-referenced and criterion-referenced measure for identifying phonological deviations

208. Three levels of Analysis Word / Syllable Structures � omissions in Syllables Consonants in sequences/clusters Consonant singletons Consonant Category Deficiencies (omissions and specific consonant substitutions) Substitution and other strategies (e.g.,assimilations)

209. Analysis Transfer phonetic transcriptions to Major Phonological Deviations Analysis Form First six columns � omissions; not marked for substitutions except for glottal. Slash each consonant omitted. Syllable Omissions Consonant Omissions Sequence OR singleton; can�t be both Mark all segments of sequence Can exceed 100%

210. Transcription C (i.e.,correct) if match target transcription or check mark �D� - delayed imitation to elicit response �I� � immediate imitation to elicit response - omissions � slash ( / ) through target sound omitted Put substitution above target phoneme Additions � insert added phoneme into transcription Target vowel under each space; if distinctly different, than write in space above vowel

211. Transcription (con�t) Nonstandard productions / Distortions � use diacritical markers Devoicing Voicing added Prolongation Nasalization Glottal stop * - no diacritical mark Unintelligible Utterances � draw line through entire transcription and transcribe utterance above target transcription

212. Consonant Category Deficiencies Score when target consonant omitted, substituted Substitutions in same consonant category NOT scored as deficiencies � go on Other Strategies Analysis Form Consonant substitutions; vowelization on Substitutions and Other Strategies Analysis Other (last column) � Backing Mark if posterior consonant substituted or target omitted

213. Substitutions and Other Strategies Analysis Form Record substitutions, distortions, additions, and position changes in word NOT for omissions Mark with check mark in column Can have more than one check mark

214. Analysis Results Total Occurrences of Major Phonological Deviations (TOMPD) Sum of word/syllable structure omissions and consonant categories deficiencies Determine severity of phonological impairment Mild Moderate Severe Profound

215. SEVERITY INTERVALS 1-50 = Mild 51-100 = Moderate 101-150 = Severe > 150 = Profound

216. Khan-Lewis Phonological Analysis Assess use of 15 phonological processes 12 developmental processes- normally suppressed 3 non-developmental - occur frequently Designed for children age 2.0- 5.11 Uses 44 words from Goldman-Fristoe Sounds-In-Words subtest Norm referenced specific age and gender breakdown score sheet in order of suppression

217. Definitions - First DFC:Deletion of final consonants - word level IV: Initial voicing - phoneme in word SR: Syllable Reduction - fewer than target PF: Palatal Fronting - front palatal consonant DF: Deaffrication - deletion of stop feature with retention of fricative feature

218. Definitions - Intermediate VF: Velar Fronting - velars to alveolars CH: consonant Harmony - one consonant influences another; only includes assimilations, not manner STR: Stridency Deletion -

219. Definitions - Last ST: Stopping of Fricatives & Affricates - does not include nasals, liquids, and glides CS: Cluster Simplification -deletion of consonant in consonant sequence or addition of schwa vowel FDV: Final Devoicing - word final voiced LS: Liquid Simplification - includes gliding and vocalization/vowelization

220. Definitions - Non-developmentalPhonological Processes DIC: Deletion of Initial Consonants GR: Glottal Replacement - replaces consonant BK: Backing to Velars - includes backing to glottal /h/ List of additional processes which can be marked in appendix A

221. Procedures Biographical information Age Intelligibility of continuous speech Record responses on sound change column Use color coding - Blue=initial Yellow = medial Green = final

222. Identify phonological processes Calculate subtotals - 3 sets Compute Developmental Phonological Process Rating & Composite Score sum the 3 subtotals convert raw scores into developmental process ratings using tables (p. 2, 6) obtain sum of 12 developmental process ratings = composite score

223. Score non-developmental phonological processes sum totals for each of 3 columns use table D.1 for % of occurrence Composite Score Summary Table D.2 = percentile rank Table D.3 = speech simplification rank Table D.4 = age equivalent Table D.5 = band of error (want 90%)

224. Factors in Considering Phonological Assessment Tool Goals of analysis features, segments, processes, phonemes unit of analysis Is data representative sample: elicited, spontaneous, modeled, named phonetic inventory; phonetic capabilities Time Factor administration time and scoring time complexity and number of forms in analyses

225. What Do You Want To Know ? Major deficiencies of child how frequent problem occurs (need to know total number of opportunities for process to calculate percentage of occurrence) remediation direction

226. Using Assessment Results Usefulness lies in prognosis & remediation planning Must be aware of all aspects of phonological-articulatory system phonological rules motoric production Organic vs. Functional pertinent case history, medical, developmental information

227. Predictive Aspect Severity of Problem number of errors types of errors Factors in determining severity percentage of consonants correct severity ratings percentage of intelligible words suprasegmentals

228. Severity Rating Scales

229. Illinois Severity Rating Severity Classifications Mild Moderate Severe Profound Rating = Service Delivery Units / Treatment Time Guidelines Determines caseload number

230. Symptom of Language Disorder Relationship between language and articulation articulation and syntax phonology and morphology sentence structure and complexity phonological errors and pragmatics

231. Measuring change in Articulation Prerequisite to remediation Continual assessment; not one-time Accountability Measurement Procedures repeated samplings probe in connected speech samples data collection to modify expectations & procedures

232. Generalization phoneme positions different stimuli different words structured to spontaneous speech clinical setting to natural environment

233. Exam II � Assessment Tuesday, November 2

235. Ann Age 5.4 yrs. Arizona Test Results: w / l w / r w / l, r in blends f / O Lateral /s/ and /z/

236. John 5.0 yrs Goldman-Fristoe Test of Articulation initial position: w/j w/l b/v d/z w/r medial position: w/l b/v dz/z d/ final position: -- b/v -- f/O Blends: /w/ for / l, r / in all blends

237. Amy 4.0 yrs. Syllable Reduction 0% Prevocalic Singleton 0% Postvocalic Singleton 60% Consonant Sequences 68% Stridents 78% Velars 50% Liquid / l / 96% Liquid / r / 100% Nasals 16 % Glides 34% Phonological Deviancy Score 55 = Severe

239. Prerequisites to Therapy Diagnostic Assessment Treatment Approach Traditional - one sound at time or cognate pair Phonological - pattern for suppression Treatment Goals

240. Traditional Methods Emphasize proper positioning of articulators correct phonetic placement variety of drill activities for different speech sounds

241. Treatment Approaches Phonetic Placement Moto-kinesthetic Sensory-motor Discrimination Minimal Pairs

242. Decision: sounds to treat first Chronological age of client - developmental appropriateness Frequency of sound in English - high frequency improved intelligibility Stimulability Close approximation Weigh all factors and decide on individual basis

243. Van Riper Traditional Approach Focus on single misarticulated sound Follow stages of correcting motor production begin with ear training sound in isolation, syllables, words, phrases, sentences, conversation stabilize correct production and transfer to non-therapy environments

244. Phase 1:  Sensory Perceptual Training Goal: Identify the standard sound and discriminate it from the error; establish internal auditory model (DO NOT PRODUCE) Identification: sound characteristics Isolation: recognize target sound when produced Stimulation: present target in varying ways Discrimination: external comparison Van Riper - prerequisite to production; others- sensory perception and production training simultaneously

245. Phase II: Production Training - Sound Establishment Goal: Establish new sound pattern to replace error pattern Auditory Stimulation/Imitation Context: facilitating phonetic environments Phonetic Placement: position of articulators Sound Approximations progressive approximation sound modification

246. Phase III: Production Training - Stabilization Goal: Produce target sound easily and quickly Isolation Phrases Nonsense Syllables Sentences Words Conversation Initial prevocalic Final postvocalic Medial intervocalic Initial blends Final blends Medial blends One syllable - all positions Multiple syllable Multiple targets, all word positions

247. Traditional Articulation Therapy Isolation Level Identify characteristics of sound to be taught Discrimination of target sound from other sounds Producing target sound auditory stimulation: imitation on demand progressive approximation: shaping closer to the target phonetic placement: position of articulators; modification of sound already mastered put in sound contexts Stabilize new production at isolated sound level

248. Traditional Articulation Therapy Syllable Level Produce sound in combination with vowels Stabilize production in nonsense syllables 1. consonant vowel (CV) 2. vowel consonant (CV) can also use doubling 3. consonant vowel consonant (CVC) Optional- nonsense words

249. Traditional Articulation Therapy Word Level Single word 1. initial position- prevocalic 2. medial position- intervocalic 3. final position- postvocalic Stabilize production at word level Short phrase/word level

250. Traditional Articulation Therapy Sentence Level Carrier phrases Controlled Sentences Spontaneous Sentences

251. Traditional Articulation Therapy Conversational Level Carry-over into controlled conversation Carry-over in spontaneous conversation

252. Phase IV: Transfer & CarryOver Goal: Transfer new skills to other environments Techniques speech assignments classmate pairing charting negative practice nucleus situations Self-monitoring essential

253. Phase V: Maintenance Goal: Retention of new skill after termination of therapy Decrease therapy gradually Periodic re-checks

254. Summary: Van Riper�s Treatment Techniques Listening Modeling Imitation Drill Practice Focus - one sound at a time Stages Ear Training Sound Establishment Stabilization Transfer & Carry-over Maintenance

255. In-class Therapy Project Choose target sound for remediation Choose level in Phase III /substage for therapy Choose age level of client Choose therapy activity to work on target level and sound Choose/make materials to conduct actual therapy activity Sign up sheet

257. General Introductory Comments Focus on process - more efficient than individual phonemes Target processes / patterns Target patterns in order should have been suppressed work on broader processes first must be system and pattern oriented Prioritize patterns child needs to target

258. Principles Underlying Phonological Approach Phonological acquisition is a gradual process Children with normal hearing typically acquire the adult sound system primarily by listening To learn new skill, child must develop both kinesthetic and auditory awareness Phonetic environment can facilitate production Children do tend to generalize

259. Programming Phonological Therapy Basic principle of cycling: introduce child to skill you want developed; give time to generalize; recheck Introduce skill and give opportunity to practice correctly spend 2-4 weeks on particular pattern NOT working on criterion level work process if over 40% in error

260. Principles of Programming Cycles Target all patterns > 40% in error Target in order of levels, lower levels first Re-evaluate after every cycle Select phonemes on basis of information from assessment logical reasoning child�s capabilities Target phonemes within process/pattern

261. Phonological Therapy Session Auditory Bombardment Production Practice Activities Probing Auditory Bombardment

262. Auditory Bombardment Do at beginning and end of every session Read list of app.15 words with day�s target Put earphones on child don�t stress or exaggerate focus child to listen can have color or play quietly if �wiggler� Save word list and send home with parents

263. Methods Choose 3-5 words that are picturable Cards are basis for 4-5 activities in session not number of words; number of correct productions go into phrases when child ready Send picture cards home for parents to do with child

264. Writing Goals

267. FINAL EXAM WEDNESDAY, DECEMBER 15, 2:45 � 4:45 Need to bring Exam Booklet Need to bring Notes, Books, Resources TWO PARTS Part One � Cumulative & Remediation Unit Format like other exams 100 points Part Two � Open book, Open note 2 cases Complete in exam booklet

268. Final Exam � Part I Basic Definitions � phonology, language Traditional sound descriptions Functional versus Organic Cause Anatomy and structures of Speech Mechanism Phonological Process Definitions Backing/Fronting, Gliding, Assimilation, Metathesis, Migration, etc. Apraxia versus Dysarthria

269. Part I - Continued Stimulability What is it? How do we determine it? Why is it important? Velopharyngeal Incompetence What is it? What effects it? Difference in Articulation versus Phonological approach to assessment and remediation How do you choose an assessment test? How do you choose a remediation approach?

270. Part I � New Material Van Riper�s Phases for Articulation Purpose / Goals What does therapy look like for each? Principles of Phonological Therapy Explain what they mean Explain how they show up in treatment Components to phonological therapy session

271. Part II � Open Notes & Books Two Cases Is therapy needed; explain Prognosis for improvement; explain What type of treatment; why Specific therapy targets; reason; order Therapy Progression Outline