Saturday, March 23, 2019

Speech Therapy

Speech is the verbal means of communication. This has three components- voice, articulation and fluency. Use of vocal cords with a controlled breathing pattern produces sound called voice. Problems in voice may be due to many reasons like infections of throat, misuse/overuse of voice resulting in hoarseness of voice or it can be loss of voice as in stroke, paralysis of vocal cord of one side. The way we make different speech sounds using our tongue, lips, nose or throat is called as the process of articulation. Any problems in this like cleft palate, problems in tongue/lip movement or even overcrowding of teeth can result in articulation disorders in addition to disorders of cerebellum which results in dysarthria( difficulty in speaking as if drunk). The rate and rhythm in which we speak constitute the fluency. Difficulties in this may result in stammering/stuttering.

Speech disorder Vs language disorders:

When a person cannot understand what others tell (receptive), then he is said to have a receptive language problem; when not able to tell (express out what he wants to say/ express) is called expressive language problem.

A problem in a person who is unable to produce speech sounds correctly or fluently, or has problems with his or her voice is called a speech disorder.

Both can exist together in one person/ separately. The use of social language in appropriate situations appropriately is called Pragmatics. Pragmatics has 3 major communication skills.

How to use language for different purposes, like

  • Greeting (e.g., Namasthae,good morning, hello, goodbye)
  • Informing (e.g., I'm going to sleep)
  • Demanding (e.g., Give me my toy car)
  • Promising (e.g., I will get you a chocolate)
  • Requesting (e.g., give me a chocolate, please)

How to change language according to the needs of a listener or situation, like

  • Talking differently to a baby (baby talk) than to an adult
  • Telling background information to an unfamiliar person
  • Speaking differently in a classroom than on a playground

Following rules for conversations and storytelling, such as

  • Taking turns in conversation
  • Introducing topics of conversation
  • Staying on topic
  • Rephrasing when misunderstood
  • How to use verbal and nonverbal signals
  • How close to stand to someone when speaking
  • How to use facial expressions and eye contact

Such a child/person will have –limited variability in conversation; disorganized story telling skills; tell inappropriate words/ things during conversation. This can cause considerable hardship to the child as other children may avoid talking to this child with a pragmatic disorder resulting in lower social acceptance as in disorders like autism.

For articulation problems: Speech therapists use three different methods to teach children the correct production of problem sounds. The three different methods include: auditory training, visual training and tactile training. During auditory training the child listens to multiple correct productions of the target sound; Visual training involves visually showing the child how to position his/her tongue, lips, teeth and jaw and Tactile training focuses on teaching children to feel the correct tongue placement and movement necessary to produce the correct sound.

Step: 1 -- Deciding where to begin. Speech therapist usually uses standardized articulation tests/screeners to determine the sounds child/clients struggles.

Step: 2 -- Then our speech therapist consider the most stimulable sounds (what sounds we can elicit from the student/client without much difficulty), and any patterns we may see among the speech errors that were produced when setting goals.

Step: 3 -- Once the speech goals are assessed and set, we use articulation goal tracking sheet to track your child/clients’ progress and to keep track of the goals to work next. Parents can always ask for our goal tracker to see the progress from our reception.

People with autism may have major problems with both speech and nonverbal communication. They may also find it very hard to interact socially. For these reasons, speech therapy is a central part of treatment for autism. Once autism is diagnosed, speech therapists assess the best ways to improve communication and enhance a person's quality of life. Speech therapy techniques might include:

  • Using sounds to which a person is over- or under-sensitive to expand and compress speech sounds
  • Using picture boards with words, known as picture exchange communication systems that start out using pictures instead of words to help a child learn to communicate
  • Improving articulation of speech by massaging or exercising lips or facial muscles
  • Having individuals sing songs composed to match the rhythm, stress, and flow of sentences
  • Electronic "talkers"
  • Signing or typing
  • Speech therapy can improve overall communication. This makes it possible for people with autism to improve their ability to form relationships and function in day-to-day life.

    Specific goals of Speech Therapy include:

    Helping the children with autism to-

  • Communicate - verbally and nonverbally
  • Comprehend verbal and nonverbal communication, understanding others' intentions in a range of settings
  • Initiate communication without prompting
  • Appropriately communicating with respect to time and place.Eg:, when to say "Namasthae; good night etc"
  • Develop conversational skills
  • Exchange ideas
  • Articulate words well
  • Communicate in ways to develop relationships
  • Enjoy communicating, playing, and interacting with peers
  • Learn self-regulation
  • Autism is usually diagnosed before age 3, and language delays can be identified by 18 months of age. Sometimes, autism can be identified as early 10 to 12 months of age. If speech therapy is started as early as possible, it can have the best results. Intensive, individualized treatment often helps to lessen social isolation that may result from this socialization disorder. Research shows those who improve the most are those who receive the speech therapy at the earliest in an integrated developmentally appropriate way.

    Here a child’s brain has difficulty coordinating the the tongue, lips, and lower jaw for speaking. Due to this neurological problem, children with apraxia struggle with sequencing and articulating sounds, syllables, and words when they are trying to speak. Hence they are difficult to understand. Apraxia is different from other motor speech disorders in that it is not caused by muscle weakness, a limited range of motion, or paralysis of any muscles.

    It is also known as Childhood apraxia of speech (CAS)/ developmental apraxia of speech. CAS is most often caused by damage of nerve cells due to infection, illness, injury, or trauma. It can also be seen in some genetic disorders, degenerative disorders, metabolic disorders, and even seizure disorders. The common characteristics of CAS are:

  • a) Late talking–
  • b) Groping: here a child searches or struggles by attempting with their tongue, lips, or lower jaw when they try to speak.
  • c) Inconsistent errors- Different kinds of errors occur when the same word is repeated again and again.
  • d) Imitated vs. Spontaneous speech: Automatic speech (i.e. counting, singing the alphabet, social greetings, etc.) and imitated speech is usually less affected than spontaneous speech.
  • e) Multisyllabic words are harder: the more complex the word, the more is the frequency of errors.
  • f) Reduced rate of speech, monotone speeches with little pitch variance, or the child may stress the wrong syllable or word.
  • g) Reduced speech intelligibility
  • When a person has stuttering speech he often has repetitions of words or parts of words, as well as prolongations of speech sounds. People who stutter usually appear very tense or "out of breath" when talking. Speech may completely stop or get blocked. Blocked - when the mouth is open to say a sound for several seconds, with little or no sound coming out. After putting effort, the person may say the word. Interjections - "um" or "like" can occur, especially like repeated ("u- um- um") or prolonged ("uuuum") speech sounds or used intentionally to delay the initiation of a word the speaker expects to "get blocked." They are aware that their speech is different and that it takes them longer to say things. Sometimes, this leads the person to feel pressure to speak quickly. Some people may have:

    • Rapid blinking (when trying to talk)
    • Trembling lips (when trying to talk)
    • Foot may tap (when trying to talk)
    • Trembling jaw (when trying to talk)
    • Face and/or upper body tighten up (when trying to talk)

    Stammering/ stuttering may have a behavioural basis (psychological), a neurological or a developmental basis as is seen in children who learn to speak (developmental stuttering)

    Why consult a developmental pediatrician and a speech therapist?

    Experts say that parents should consider visiting their developmental pediatrician/ primary care physician) when:

    • The child's stuttering lasts over six months
    • Stuttering / stammering more frequently
    • Along with tightness of the facial and upper body muscles
    • If interferes with schoolwork
    • Causing emotional difficulties Eg: as fear of facing situations
    • Persisting > 5 years old

    The speech therapist will assess the number of times speech dysfluencies occur in different situations, and the different type of dysfluencies, the coping strategies with dysfluencies , the social reaction to stammering like teasing, which can exacerbate their problems. The Speech therapist also assesses speech rate and language skills, will analyze the data and determine any fluency disorder. After assessing we start correcting the respective conditions including buy giving a Psychological support, if needed, in addition to speech therapy for stammering.

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