SPEECH DISORDERS

Pembimbing: dr. Martha Kurnia K., Sp. K.F.R. N.M (K)

Oleh : ARA
REFERENCE
 SPEECH AND SPEECH DISORDERS
Speech refers specifically to
sounds produced by the oral
mechanism, including the
lips, tongue, vocal cords, and
related structures.
Speech Disorders refer to problems in
producing the sounds of speech or with
the quality of voice.
People with speech disorders may:
 not say sounds clearly
 have a hoarse or raspy voice
 repeatsounds or pause when
speaking
 LANGUAGE DISORDERS VS
SPEECH DISORDERS
Language refers to the code, or a
system of words and symbols—written,
spoken or expressed with gestures and
body language—that is used to
communicate meaning and for
transforming unobservable mental
events, such as thoughts and memories,
into events that can be perceived by
other people.
Language Disorders are an impairment
of either understanding linguistic
information (Receptive Language) or
the ability to use and share linguistic
information (Expressive Language)
and are not related with speech
production.
 CLASSIFICATION OF
SPEECH DISORDERS

Speech
Fluency Voice
Sound
Disorders Disorders
Disorders
1 SPEECH SOUND DISORDERS
• A Speech Sound Disorder (SSD) is a speech disorder in which some speech
sounds (called phonemes) are either not produced, not produced correctly, or are
not used correctly.
• Speech sound disorders can be organic or functional in nature.
Organic Speech Sound Disorders result from an underlying motor/neurological,
structural, or sensory/perceptual cause.

Functional Speech Sound Disorders are idiopathic—they have no known cause.

 ORGANIC VS FUNCTIONAL SPEECH
SOUND DISORDERS
Organic Speech Sound Disorders Functional Speech Sound Disorders
Include those resulting from:
 Motor/Neurological Disorders (e.g., childhood Include those related to the:
apraxia of speech and dysarthria)
 Structural  Motor Production of Speech Sounds
Abnormalities(e.g., cleft
lip/palate and other structural deficits or (articulation disorders)
anomalies)  Linguistic
Aspects of Speech Production
 Sensory/Perceptual Disorders (e.g., (phonological disorders)
hearing impairment).
 “Be vewwy vewwy
quiet…I’m
hunting wabbits.”

Articulation Disorder (A Speech Sound

Disorder)
 ARTICULATION DISORDERS AND
PHONOLOGICAL DISORDERS
 Articulation disorders (Phonetic Disorders) focus
on errors (e.g., omissions, substitutions, and
distortions) in production of individual speech sounds.
1. Omissions:(bo for boat)
2. Substitutions: (wabbit for rabbit)
3. Distortions: (shlip for sip)
 It is often difficult to clearly differentiate between
articulation and phonological disorders; therefore,
many researchers and clinicians prefer to use the
broader term "speech sound disorder" when referring
to speech errors of unknown cause.
Phonological Disorders (Phonemic Disorders) focus on
predictable, rule-based errors (e.g., fronting, stopping, and
final consonant deletion) that affect more than one sound.
Phonological disorders are considered both speech and
language disorders because it is the language system that is
affected but they are also a speech sound disorders in that
the errors relate to use of phonemes (speech sounds).
This makes it different from specific language impairment,
which are primarily disorders of the morphology (word
structure), syntax (grammar), semantics (meaning) and
pragmatics (usage) of language rather than the sound
system.
 APRAXIA OF SPEECH AND
DYSARTHRIA
• The muscles involved in speech need to move in a coordinated manner in order
Apraxia of Speech to produce Speech Sounds. These movements are controlled by brain and are
(AOS) or Acquired also dependent upon speech muscles strength
Apraxia of Speech • In Apraxia, the speech muscles are normal and of normal strength but the brain
signals that control movements of these muscles during speech become
abnormal
Childhood Apraxia • In Dysarthria, the brain signals that control movement of speech muscles
during speech are normal but speech muscles are weak and not able to move
of Speech (CAS)

Dysarthria
 DYSARTHRIA

Dysarthria is a motor speech disorder resulting from impaired movement

of the muscles used for the production of speech.

The main parameters of speech are respiration, phonation, resonance,

articulation and prosody. One or more of these parameters can be
affected leading to reduced speech intelligibility and reduced
communication effectiveness.
 APRAXIA

Apraxia of speech (AOS), also known as verbal apraxia or dyspraxia,

is also a motor speech disorder.

AOS results from a reduction in the ability to co-ordinate the gestures

required for speech leading to difficulty producing the right sounds in
the right order when speaking.

It is characterised by multiple different attempts to articulate words

accurately. AOS can occur in isolation, but frequently coincides with
expressive aphasia.
2 FLUENCY DISORDERS
• Fluency is the aspect of speech production that refers to continuity, smoothness, rate, and effort.
• Fluency disorders are difficulties with the rhythm and timing of speech characterized by
hesitations, repetitions, or prolongations of sounds, syllables, words, or phrases. Common
fluency disorders include:

Stuttering: rapid-fire repetitions of consonant or vowel sounds especially at the

beginning of words, prolongations, hesitations, interjections, and complete verbal blocks

Cluttering: excessively fast and jerky speech

 “I w-w-w- want
a job.”

Stuttering (A Fluency Disorder)

3 VOICE DISORDERS
• Voice disorders are problems with the quality or use of one's voice resulting from
disorders in the larynx. Voice disorders are characterized by abnormal production and/or
absences of vocal quality, pitch, loudness, resonance, and/or duration.
•Voice Disorders are classified as:

Organic — voice disorders that are physiological in nature

Functional — voice disorders when the physical structure is normal

 ORGANIC AND FUNCTIONAL
VOICE DISORDERS

•
Organic Voice Disorders
Are physiological in nature and result from alterations
Functional Voice Disorders
in respiratory, laryngeal, or vocal tract mechanisms
1. Structural  organic voice disorders that result
from physical changes in the voice mechanism (e.g.,
alterations in vocal fold tissues such as edema or • Result from improper or inefficient use of the vocal
vocal nodules; structural changes in the larynx due mechanism when the physical structure is normal (e.g.,
to aging) vocal fatigue; muscle tension dysphonia or aphonia;
2. Neurogenic  organic voice disorders that result diplophonia; ventricular phonation)
from problems with the central or peripheral nervous
system innervation to the larynx that affect
functioning of the vocal mechanism (e.g., vocal
tremor, spasmodic dysphonia, or paralysis of vocal
folds)
 APHASIA ASSESMENT
• Commonly used assessments of impairment that have been validated or
shown to be reliable include the Western Aphasia Battery (WAB),
Boston Diagnostic Aphasia Examination (BDAE-2) and the
Comprehensive Aphasia Test (CAT), Aachen Aphasia Test (AAT),
Minnesota Aphasia Test (MAT), Porch Index of Communication
Ability (PICA) and the Frenchay Dysarthria Assessment (FDA-2).

Pubmed, NCBI
DYSARTHRIA AND AOS ASSESMENT
• Case History: education, vocation, medical history
• Nonspeech Examination: Cranial Nerves, facial and neck muscle tone, etc
• Speech production: vocal quality, stress testing, motor speech planning
• Prosody: pitch, loudness, duration, emotion
• Speech Intelligibility: familiar/unfamiliar
• Comprehensibility
• Efficiency
American Speech-Language-Hearing Association
The Frenchay Dysarthria Assessment
The Apraxia Battery for Adults
CHARACTERISTICS

American Speech-Language-Hearing Association

 REHABILITATION
DYSARTHRIA THERAPY
• Behavioural Therapy Interventions, includes:
1. Articulation exercises practising precision in the production of single sounds, words and
sentences;
2. Modelling correct pronunciation of words and sentences and providing feedback ‘clear’ or
‘unclear’ on repeated attempts;
3. Use of visual feedback to increase the use of pitch, loudness and intonation (prosody) and use
of the Lee Silverman technique to increase loudness, pacing techniques to slow rate (using a
metronome)
4. Purposeful speech production such as over-articulation or slowing rate of speech can be used.
Pubmed, NCBI
 REHABILITATION
AOS THERAPY
• Behavioural Therapy Interventions, includes:
1. Kinematic approaches involve motoric practice (repetitive practice of phonemes
building in complexity), modelling and repetition (watching listening and speaking
with the therapist) and articulatory cuing (involving sound production treatment using
minimal pair words and prompt for restructuring oral muscular phonemic targets, e.g.
tactile cues for accurate articulation placement (PROMPT).
2. Rate-rhythm approaches use prosodic patterns, e.g. melody, rhythm and stress to
improve speech production
Pubmed, NCBI
THANK YOU
FOR THE ATTENTION
 DYSARTHRIA TYPES
Listed below are examples of some specific etiologies, grouped into broad categories (Duffy, 2013).
• Congenital—cerebral palsy, Chiari malformation, congenital suprabulbar palsy, syringomyelia, syringobulbia
• Degenerative diseases—amyotrophic lateral sclerosis, Parkinson's disease, progressive supranuclear palsy, cerebellar degeneration, corticobasal
degeneration, multiple system atrophy, Friedreich's ataxia, Huntington's disease, olivopontocerebellar atrophy, spinocerebellar ataxia, ataxia telangiectasia
• Demyelinating and inflammatory diseases—multiple sclerosis, encephalitis, Guillain-Barré and associated autoimmune syndromes, meningitis, multifocal
leukoencephalopathy
• Infectious diseases—acquired immune deficiency syndrome (AIDS), Creutzfeldt-Jakob disease, herpes zoster, infectious encephalopathy, central nervous
system tuberculosis, poliomyelitis
• Neoplastic diseases—central nervous system tumors; cerebral, cerebellar, or brainstem tumors; paraneoplastic cerebellar degeneration
• Other neurologic conditions—hydrocephalus, Meige syndrome, myoclonic epilepsy, neuroacanthocytosis, radiation necrosis, sarcoidosis, seizure disorder,
Tourette's syndrome, Chorea gravidarum
• Toxic/metabolic diseases—botulism, carbon monoxide poisoning, central pontine myelinolysis, heavy metal or chemical toxicity, hepatocerebral
degeneration, hypothyroidism, hypoxic encephalopathy, lithium toxicity, Wilson's disease
• Trauma—traumatic brain injury, chronic traumatic encephalopathy, neck trauma, neurosurgical/postoperative trauma, skull fracture
• Vascular Diseases—stroke (hemorrhagic or nonhemorrhagic), Moyamoya disease, anoxic or hypoxic encephalopathy, arteriovenous malformations