Syllabic nasals – How do we treat them? - PowerPoint Presentation

Slide1

Syllabic nasals – How do we treat them?

Caroline Hattee

Cleft Net East Slide2

Study resultsTherapy ideasDiagnostic implications

Aims Slide3

Retrospective case note reviewN= 9 ( 6 non cleft, 2 cleft, 1 SMCP)

Assessed using the STAP and GOSSPASS

Consonant and vowel inventory tabulated and nasality and nasal airflow noted

StudySlide4

SubjectsSlide5

Therapy eliminated syllabic nasals in 8/9 cases.3/9 prolonged therapy1/9 persisting syllabic nasals

1/9 secondary speech surgery during this treatment period.

Close vowels /i,

Ì

, u/ (and for the diphthongs containing these) tended to respond most quickly to therapy.

OutcomesSlide6

TherapySlide7

Auditory perceptual approaches

Input modelling/vowel bombardment

therapy

(e.g. Hope

cochlear implant ideas hope.cochlear

americas.com

)

Audio

and

Video therapy e.g.

lorry reversing iiii ; u for cow

Headphone

use as playback in video therapy – optimal proximity of sound

Vowel Therapy to update input processingSlide8

Input : Extended vowel duration (

Rusche

et al 2004

)

Increased pitch via Melodic Intonation Therapy (Helfrich-Miller 1984) –counting 1-6 contains

u/

i

/

Ì

.

Hope cochlear website has good resources in pitch unit section.

Output : immediate

verbal feedback for each production as “incorrect” placement information or sensory feedback can hamper potential for subsequent target sound production (Ruscello 2008).

Vowel Therapy to update vowel perceptionSlide9

Video TK orlSlide10

Visual feedback

Historical

glossometry

; speech viewer

EPG

The future - MRI imaging/ultrasound

Computer

approaches

PC programmes –; SAILS (

Rvachew

et al 2004)

;

Earobics (Earobics cognitive Concepts 2000); Phoneme factory (Wren &Roulstone 2006); LiPS(Lindamood & Lindamood 1998);

Nessy

language programme

.

Apps

available - vowel

viz and IPA vowels; cued articulation; vowels central

Vowel TherapySlide11

Vowel vizAppsSlide12

Linguistic approaches:

Maximal

contrast therapy : contrasting open front

vowels with

close back vowels. Metaphonological

– e.g. The vowel house/

Metaphon

– visual referent lip rounding vs lip spread

Core vocabulary (Cosbie,et al 2006).

Semantic/rhyme sets e.g. baby/mummy/dummy.

Vowel TherapySlide13

Motor approachesNuffield

production and sequencing (Williams and Stephens 2010

).

PROMPT

Cued vowels

Vowel TherapySlide14

Assess consonants and vowels; notice weak syllables

Hearing

levels and complexity of speech disorder important prognostic factors – maximise visual and auditory input

Implications for future PracticeSlide15

Diagnostic therapy may help differentiate between syllabic nasals and nasalised vowels

Syllabic

nasals do respond to therapy

Detailed

notes of therapy aims and methods needed to inform outcome. Ideally video pre and post therapy

SLT

Training

at undergraduate level

Further research opportunities

Implications for future practiceSlide16

Geirut 1998 “ direct therapy for vowels can have a positive outcome”

But…..

Gibbon 2013 “one approach not advocated is non speech oral motor activities as there is no evidence to suggest that these methods are effective”.

ConclusionSlide17

Don’t be alarmed – go for it !Slide18

Jennie Smith – Specialist SLt Cleft Net East Anne Harding-Bell Module Co-ordinator, Human Communication Sciences, University of Sheffield

AcknowledgementsSlide19

Video data of case examples to be made available via SIG website

Forthcoming text

Purdy S, Harding-Bell , Differential diagnosis :signs of conductive hearing loss

In Case Studies of Cleft Palate Speech. Ed Harding-Bell, A. J&R Press (Forthcoming)

Additional Resources Slide20

Ball,M.J,Gibbon,F.E.(2013).Handbook of Vowels and Vowel Disorders.Psychology Press

Hope Cochlear Implant Ideas

www.cochlear.com/rehabilitation-resources

Cosbie,S,Pine,C,Holm,A and Dodd,B.(2006).Treating Jarrod:A core vocabulary approach.Advances in Speech-Language Pathology,8(3),316-321

.

Gierut,J.A(1988)Treatment efficiency:functional phonolgydisorders in children.Journal of Speech, Language Haring Research 41,85-100

Gibbon, F(2013).Therapy for abnormal vowels in children withspeech

disorders in Ball,M.J,Gibbon,F.E.(2013).Handbook of Vowels and Vowel Disorders.Psychology

Press

Hayden,D,A,Eigen,J,Walker,A,Olsen,L.(2010)PROMPT:A Tactually grounded model. In Williams,Smcleaod, and R

Mcauley

(

eds)Interventions for speech sound disorders in children.Brookes:Baltimore.Helfrich-Miller,KR.(1984).Melodic Intonation therapy with developmentally apraxic children.In Perkins WH,Northern JL.Editors:Seminars in speech and Language .New York.

Passy,J

(1990)Cued

Vowels.Ponteland:STASS

publications. Also available as app

Ruscello,D.M. (2008).Treating Articulation and Phonological Disorders in

Children.Mosby

Reid,J

(2003)The Vowel

House.A

cognitive approach to vowels for literacy and

speech.Child

Language Teaching and Therapy,19,152-180.

Rusche, N., Markovitz, S., & Kwiatkowski, J. (2004, November).

Treating vowel errors in speech-delay: A case study.

Poster presented at the Annual Convention of the American Speech-Language-Hearing Association, Philadelphia, PA

Shriberg,LD,Friel-Path,S,Flipsen,P.(2000).Otitis media, Fluctuating hearing loss and speech – language outcomes:a preliminary structural equation model.Journal Speech Language Hearing Research 43:100-120.

ReferencesSlide21

Rvachew,S;Slawinski,E,B;Williams,M.(1996) Formant frequencies of vowels produced by infants with and withot early nset otitis media.Canadian Acoustics24(2),19-28Ferdos,N;Ashayer,A;Modarresi,Y;Rovshan,B.(2014)The effectiveness of melodic intonation therapy on fundametal frequency and intensity in Persian autistic children’s speech.Audiology23(2):74-82

Williams,P&StephensH.(2010).The Nuffield Centre Dyspraxia Porgramme.

References