INTRODUCTION OF SPEECH THERAPY

Speech therapy is the assessment and treatment of conversational skills of a needy person or a child, who has speech and language disorders. It is performed by speech therapists.

  Speech therapists use speech & language techniques to improve communication of a child or needy person. These include, articulation therapy, language intervention activities and others depending on the type of speech or language disorder.

Speech therapy may be needed for speech disorders that develop in childhood or speech impairments in adults caused by an injury or illness, such as stroke or brain or brain injury.

Some children do not begin to talk until five or six years of age, but many of them could learn earlier with proper parental teaching. In general, the  same procedures used on other delayed-speech cases and in teaching the baby to talk are employed.  

Speech and language disorders are as below:–

There are some speech and language disorders that can be treated by speech therapy.

Fluency Disorders :

An aspect of speech and language disorder production, quality or state of being fluent.

Speech disorders characterized by excessive amount of dysfluencies or excessive duration of dysfluencies lr both, and speech that is produced with excessive amounts of struggle effort (stuttering); speech that is characterized; by excessively fast rate, indistinct articulation and possibly language formulation problems Cluttering impairing fluency due to Neurogenic Fluency Disorders, Stuttering is the most researched, and more frequently diagnosed and treated fluency disorder. 

 

Fluent Speech:

Speech that is smooth, flowing, effortless, rapid within acceptable limits; negatively defined, it is speech that does not contain excessive amounts of pauses, repetitions, sound and silent  prolongations, interjections and other forms of dysfluencies; speech that is not produced with excessive effort struggle.

Resonance Disorders :

Resonance disorder is speaking sound produced through Nasal cavity.

Reasons for sound producing are cleft lip and cleft palate.



General Principles:

  • Do not treat Hypernasality if it is a result of velopharyngeal incompetence.
  • Treat hypernasality only if the child is capable of achieving velopharyngeal closer
  • See if surgery reduces hypernasality; improvement may continue for up to a year following surgery.



Treatment Procedures of Resonance Disorders :

  •  Use techniques described under Voice Disorders to reduce hypernasality including increased loudness, discrimination training to distinguish oral and nasal resonance, lowered pitch, and increased oral opening.
  • Use respiratory training to improve loudness
  • Attempt articulation with the nares occluded
  • Decrease intra-oral breath pressure on stop consonants and fricatives, while simultaneously using loose articulatory contacts
  • Use such biofeedback instruments as Tonar IITM to reduce hypernasality
  • Use the whistle-blowing technique of R.M. Shprintzen and his associates to promote velopharyngeal closure during speech:

– teach whistling and blowing at the same time

– reinforce when nasal airflow is absent

– continue until there is no nasal escape during whistling or blowing

– eliminate whistling or blowing, and introduce phonation

– continue until no nasal escape is evident

– introduce vowels /i/ or /u/ while bowling or whistling

– continue until there is no longer nasal escape

– eliminate blowing or whistling, and produce only the vowels

– form monosyllables by using non-nasal consonant  with vowels

– move to words, sentences, and conversations

– teach self monitoring skills.



Language Disorder :

Difficulty in learning to comprehend and/or produce language in a varied group  of children some of whom have associated clinical conditions while others show on such conditions, also referred to as language Delay. Language Disabilities Language Deviance, Language Impairment, Language-Learning Disorders, and Language Problems: the term childhood or Congenital Aphasia is dated and controversial; the term Specific Language Impairment refers to a special group of children with language  problems with no other difficulties, also controversial.

Receptive language is the input of language that is  the ability to understand and comprehend spoken language that we hear or read. E.g. A child’s understanding or listening ability is depends on  his/ her attention criteria :                                                                                              



Receptive Language:

Following Points To Develop Receptive Language :
  • A good behavior must be in a child to develop receptive language,
  • Reading and writing skill is compulsory in the child to develop receptive langAttention and concentration is the much more compulsory to develop the receptive language of a needy child,
  • Pre-language skills are also very important to a needy child to develop the receptive language,
  • Social skills are most  compulsory to a needy child to develop the receptive  language,
  • Play skills are also compulsory to develop receptive language to a needy child, we want a needy child play with other children  normally,
  • usage,

Expressive Language:

A person or a child expresses his feelings and emotions with others, which is an expressive language. If a child or a person cannot express his feelings and emotions with others, which is a language disorder. 

We can improve Receptive and expressive language of that person and child by speech therapy as following steps:



Treatment of Language Disorder:

  • General Treatment Procedure:


  • Specific Techniques or Programs:
  • Activity-Based Language Intervention
  • Child-Centered Approaches to Language Intervention
  • Conversational Repair
  • Conversational Skill
  • Delayed Stimulus Presentation
  • Direct Language Treatment Approaches
  • Environmental Language Intervention Strategy (ELIS)
  • Event Structures in Language Treatment
  • Expansions
  • Expatiations
  • Extensions
  • Eye contact
  • Focused Stimulation
  • Imitation of Child’s Utterances
  • Incidental Teaching Method
  • Indirect Language Stimulation
  • Integrated Functional Intervention
  • Interactive Language Development Teaching
  • Joint Action Routine or Interactions
  • Joint Book Reading
  • Mand-Model
  • Matching-to-Sample
  • Milieu Teaching
  • Narrative Skills Training
  • Naturalistic Child Language Teaching Method
  • Parallel-Talk
  • Peer Modeling
  • Reauditorization
  • Rcast
  • Request for Repair
  • Scaffolding
  • Script Therapy
  • Self-Talk
  • Story Grammar
  • Topic Initiation (Treatment for)
  • Topic Maintenance (Treatment for)
  • Turn Taking (Treatment for)
  • Whole Language Approach



Articulation Disorder:

Disorder of speech characterized by difficulty in producing speech sounds correctly; sounds may be omitted, distorted, or substituted; difficulty in producing a few sounds with no pattern or derivable rule is often described as an articulation disorder; multiple errors that can be grouped on some principle or characteristics and thus form patterns are typically described as phonological Disorders.

 

A General Articulation Treatment Procedure:

  • Assess the client’s articulation skills
  • Select the target speech sounds for modification
  • Prepare stimulus materials 
  • Establish Baselines of target sounds in words, phrases, and sentences
  • Write training and probe criteria
  • Train sounds at the word or syllable level
  • Use the Multiple  Phoneme Approach
  • Reinforcer the correct responses
  • General Production
  • Response Complexity
  • Select other individual sounds
  • Conduct informal training sessions
  • Train family members, teachers, and peers 
  • Teach the client Self-Control Self-Monitoring
  • Follow-up and provide booster treatment

 

Specific Techniques or Programs:

  • Behavioral Approaches
  • Programmed Conditioning for Articulation
  • Contrast Approach
  • Minimal Pair Contrast Method
  • Maximal Pair Contrast Method 
  • Cycles Approach
  • Multiple Phoneme Approach
  • Paired-Stimuli Approach 
  • Phonological Knowledge Approach
  • Phonological Process Approach
  • Sensory-Motor Approach 
  • Traditional Approach

Aphasia:

A language disorder caused by brain injury in which:

  1. All aspects of language comprehension and production are impaired to varying degrees (a non-typological definition);
  2. One or more aspects of language comprehension and language production may be affected (a typological definition).

Treatment of Aphasia: General Guidelines

  • Auditory Comprehension; 

Factors That Promote Auditory Comprehension

  • Sequence of Auditory Comprehension Treatment; 

Comprehension of Single Words 

  • Comprehension of Spoken Sentences
  • Comprehension of Spoken Questions
  • Comprehension of Spoken Directions
  • Comprehension of Discourse



Treatment of Aphasia: Verbal Expression (Treatment of Naming)

  • Designing Problem-specific Strategies:

  Design treatment to suit the kind of anomia present:

  1. i) word production anomia; ii) word selection anomia; iii) Semantic anomia; iv) Limited anomia; v) Delayed response; vi) Self-corrected errors; vii) Preservation; viii) Unrelated words; ix) Paraphasias; 
  • General Considerations:
  • Targets and techniques

–  Confrontation Naming: Treatment Procedure,

–  Naming in General: Treatment Procedure

      – Types of Cues:

– Modeling; 

– Sentence Completion;

– Phonetic cues;

– Syllabic cues;

– Silent Phonetic cues;

– Functional descriptions as cues;

– Description and demonstration of an action as cues;

– Client description as cues;

– Patient’s demonstrations of functions as cues;

– Objects or pictures with their printed names as cues;

– Patient’s oral spelling as cues;

– Patient’s spelling and writing as  cues;

– Presentation of sound as a cues

      –   Direct and Indirect Deblocking:

Treatment of Aphasia: functional Communication Treatment of Aphasia : Specific Types

Global Aphasia:

A type of aphasia characterized by severe deficits in comprehension and production of language ; all sensory modalities may be affected; caused by widespread damage to language areas of the brain.

Transcortical Motor Aphasia:

A type of nonfluent aphasia characterized by agrammatic, paraphasic, and telegraphic speech; distinguishing feature is intact repetition; lesion is typically outside Broca’s area, found often in the deep portions of the left frontal lobe or below of above Broca’s area.

  • Use limitation and naming to improve speaking
  • Use relatively intact reading skills to prime or promote Speaking;
  •  

 

Wernicke’s Aphasia:

A type of fluent aphasia characterized by good or even excessive fluency of speech, rapid rate, normal articulation and prosody, good grammatical structures, paraphasia, neologism, jargon, and generally meaningless speech; poor auditory comprehension is a major distinguishing feature; the lesion is in Wornicke’s area.

Treatment of Aphasia: Specific techniques or Programs:
  • Gestural Reorganization
  • Helm  Elicited Program for Syntax Stimulation
  • Background and preparation
  • Melodic Intonation Therapy (MIT)
  • Program of Changing Criteria
  • Promoting Aphasics’ Communicative Effectiveness (PACE)
  • Schuell’s Auditory Stimulations Approach for Aphasia
  • Treatment for Wernicke’s Aphasia (TQA)
  • Visual Action Therapy (VAT)

– Matching pictures and objects

– Object use training 

– Action Picture demonstration

– Action picture commands

– Pantomimed gesture demonstration

– Pantomimed gesture recognition

– Pantomimed gesture production

– Representation of hidden objects demonstration

– Production of gestures for hidden objects





Voice Disorder:

Various disorders of communication related ro faulty, abnormal, or inappropriate phonation, loudness pitch, and  resonance;  causes include  vocally abusive behaviors, trauma to the laryngeal mechanism, and physical diseases;  may be treated  both medically and behaviorally; some only medically; and others only behaviorally; many types of voice disorder as below:-

 

  • Voice Disorder of Loudness
  • Voice Disorder of Pitch
  • Voice Disorder of Phonation: Abuse-based; Physically-based
  • Voice Disorders of  Resonance.

 

Treatment of Voice Disorders 

 

Treatment of Loudness  and  Pitch

 

Treatment of Excessively Loud Voice

 

Treatment of Excessively Soft Voice

 

Treatment of Pitch Disorders

  • Treatment to Raise the Baseline Pitch
  • Treatment to Lower the Baseline Pitch

 

Treatment of Disorders of Phonation

  • Treatment of Abuse-Based Disorders of Phonation
  • Treatment of Physically Based Disorders of Phonation

 

Treatment of Disorders of Resonance

  • General Principles
  • Treatment of Hypernasality
  • Treatment of Hyponasality

 

Treatment of Vocally Abusive Behaviors

 

 





Dysarthria:

A group of motor speech disorders resulting from disturbed muscular control of the speech mechanism due to damage of the peripheral or central nervous system; oral communication problems due to weakness, incoordination, or paralysis of speech musculature; classified into types including;

 

  • Ataxic Dysarthria

 

  • Flaccid Dysarthria

 

  • Hyperkinetic Dysarthria

 

  • Hypokinetic Dysarthria

 

  • Mixed Dysarthria

 

  • Spastic Dysarthria

 

  • Unilateral  Upper Motor Neuron Dysarthria



General Guidelines on Treatment

  • Provide counseling and support
  • General Treatment Goals for Clients with Dysarthria

 

General Treatment Procedures

 

Modification of Respiration

 

Modification of Resonance

 

Modification of Articulation

 

To improve speech rate

 

Modification of Prosody





Dysphagia:

Disorders of swallowing; associated with many medical condition including neuromuscular disorders and cancer and its surgical treatment of structures involved in swallowing; may occur at any age although more common in the elderly; Includes:

  • Disorders of mastication
  • Disorders of the preparatory phase of the swallow
  • Disorders of the oral phase of the swallow
  • Disorders of the pharyngeal stage of the swallow
  • Disorder of the esophageal phase of the swallow



Treatment of Dysphagia:

  • Direct Treatment of Dysphagia

– Disorders of mastication

– Disorders of the preparatory phase of the swallow

– Disorders of the oral phase of the swallow

– Disorders of the pharyngeal stage of the swallow

– Disorders of the esophageal phase of the swallow


  • Indirect Treatment of Dysphagia

– Oral-motor control exercises

– Stimulating the swallow reflex

– Improving adduction of tissues at the top of the airway


  • Medical Treatment of Dysphagia

–  Cricopharyngeal Myotomy

–  Esophagostomy

–  Gastrostomy

–  Nasogastric Feeding

–  Pharyngostomy

–  Teflon Injection into Vocal fold

Dysphonia:

A general term that means disordered voice; any voice disorder with the exception of Aphonia.

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Movements that are repetitive, slow, twisting, writhing, and flexing. Uncontrolled adductor, laryngeal spasms occur, voice is breathy, strained, and hoarse




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