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MANAGEMENT UPDATE Speech Delay Yud
MANAGEMENT UPDATE Speech Delay Yud
Speech delay
4
Dimensi
bicara & bahasa
Definition
Definition
Prevalence
The Difference between speech and language
Primary speech-language delay/disorder
• Developmental speech-language delay/disorder
• Expressive speech-language delay/disorder
• Receptive speech-language delay/disorder
• Receptive-expressive language imparment (RELI)
Secondary speech-language delay/disorder
• Gangguan pendengaran
• Disabilitas intelektual
• Gangguan spektrum autisme
• Mutisme selektif
• Palsi serebral
• Apraksia, dll
Speech-language delay/disorder
Historical Information in
the Evaluation of •Psychosocial deprivation,
•elective mutism
Speech Delay in •Autism
Children •Mental retardation •Bilingualism
•Maturation delay •cerebral palsy
•Hearing loss SPEECH
•Hearing loss DELAY
•mental retardation
Past health •one language
•Mental retardation
Encephalitis, •Psychosocial
•cerebral palsy history
Family history meningitis
Recurrent otitis
•Hearing loss - Speech delay
media
•mental retardation Perinatal - Chromosomal Mumps
history abnormalities Hypothyroidism
•Hypoxia Head trauma
•Speech delay •Prematurity
- Prader-Willi
•Cerebral palsy
Maternal syndrome, etc Seizures
illness/ use of •Birth trauma
•Mental retardation •Intracranial
drug during
pregnancy hemorrhage
•Kernicterus
Development •Intrauterine
history infection
•Maternal
•Delay in language
milestone phenylketonuria,
•Delay in motor Hypothiroid,use
milestone of drugs
•Generalized delay •Placental
insufficiency
Leung AKC, Pion Kao C. Evaluation and management of the child with
speech delay. American Academy of Family Physician, June 1999.
Physical findings
in the Evaluation of
Speech Delay in Microcephaly,
Children macrocephaly
extensor
plantar Deformities of
response, Mental retardation, auricle or
contractures external ear
canal
cerebral palsy,
hearing lossETIOLOGY
POSSIBLE
Hearing loss
Upward slanting
Spasticity, Down syndrome eyes, Brushfield
hyperreflexia, spot, epicanthic
clonus, Autism folds, brachycephaly,
simian creases
Cerebral palsi
Leung AKC, Pion Kao C.
Evaluation and
management of the
child with speech delay.
Lack of eye American Academy of
repetitive Family Physician, June
contact,
motor activity 1999
stereotyped
Table 1. Signs of speech or language delay by type of disability
Autism normal
Parker S, Zuckerman B, Augustyn M. Developmental and Behavioral Pediatrics(2nd ed): Language Delays.
Philadelphia: Lippincott Williams & Wilkins,2005
Five main types of speech defects :
(1) articulation problems, such as the inability to produce
certain sounds
(2) stammering, cluttering (rapid, slurred speech), and other
fluency problems
(3) voice disorders, including problems of pitch, voice quality,
and volume
(4) delayed speech, characterized by a child's slow language
development
(5) aphasia, the partial or total loss of the ability to speak or
understand language.
Adapted from:
www.pediatrics.org at Indonesia:AAP Sponsored on May 4, 2008
Speech Therapy http://www.a2zpsychology.com/psychology_guide/speech_therapy.htm
Algorithme for evaluating
of the Child with a Language Disorder
Child with a Language Disorder
A History
Language Test C
B Physical Examination
NO YES
E Audiology Assessment
F Conductive Sensorineural G
Feldman HM. Language disorders. Dalam : Berman S, penyunting. Pediatric Decision Making. Edisi ke-4. Philadelphia: Mosby, 2003.h.94-97
In all cases of suspected speech and
language delay, audiometry and a
good clinical evaluation of the
central nervous system and ear,
nose, and throat are mandatory.
Identify and treat
underlying condition or disorder :
Neurologic disorder
Genetic syndrome / disorder
Metabolic disorder
Endocrine disorder
Mental health disorder
Social deprivation
BACK
Sensorineural Hearing Loss
Refer to :
Audiologist
Speech clinician
BACK
Conductive Hearing Loss
BACK
Multiple Domain
Identify :
Global development delays
Mental retardation
Autism spectrum disorder
Social deprivation
Refer to :
Behavioral / developmental
pediatrician
Early intervention program
Consider :
Mental health professional
Social service agency BACK
Development Language Disorder
Refer to :
Early intervention program
Speech clinician
BACK
Speech Disorder
Identify : Identify :
Phonologic disorder Trancient
Verbal apraxia Dysfluency
Stuttering
Refer to : Follow up :
Speech Clinician Observe
BACK
• Beragam, selaras dengan variasi gangguan
bicara-bahasa
• Bentuk/jenis
• Pendekatan
• Durasi
Terapi wicara- • Intensitas
• Setting terapi : rumah sakit/klinik, rumah,
bahasa sekolah
• Secara individual atau kelompok
• Pelaksana : klinisi/terapis wicara, orang
tua/pengasuh yang terlatih
Terapi wicara-bahasa
area intervensi dan luaran
• Fonologi
Ekspresif • Sintaks
• Kosakata
• Fonologi
Reseptif • Sintaks
• Kosakata
• Harus ada keselarasan antara area intervensi dan luaran yang dinilai
• Dalam satu sesi terapi dapat dikombinasikan intervensi ekspresif dan
reseptif dalam ketiga subset
Terapi wicara-bahasa : efikasi ?
3 meta analisis
1) Law J, Garrett Z, Nye C. Speech and language therapy intervention for
children with primary speech and language delay or disorder. Cochrane
Database Syst Rev 2003 (last updated 2010)
2) Law J, Garrett Z, Nye C, Zoe G. The efficacy of treatment for children
with developmental speech and language delay/disorder: a meta
analysis. J Speech, language, and Hearing Res 2004;47(4):924-43
3) Law J. The implication of different appraaches to evaluating
intervention: evidence from the study of language delay/disorder. Folia
Phoniatrica et Logopaedica 2004;56(4):199-219
Terapi wicara-bahasa : outcome ekspresif fonologi
Perbaikan bermakna
kemampuan ekspresif fonologi
Terapi wicara-bahasa : outcome ekspresif sintaks