Caroline Hattee
Cleft Net East
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Study results
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Therapy ideas
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Diagnostic implications
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Retrospective case note review
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N= 9 ( 6 non cleft, 2 cleft, 1 SMCP)
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Assessed using the STAP and GOSSPASS
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Consonant and vowel inventory tabulated and
nasality and nasal airflow noted
Subject
Age at
assessmnt
(years)
Reason
for
referral
Vowels
replaced
by syllabic
nasal
Speech and
language
diagnosis
Hearing History
1 TA
2.2
Sus VPD
iu
Disordered
Phonology/Dyspraxia
None
2 LS
1.10
Sus VPD
i u ei
Dyspraxia/disordered
speech
Min loss reported by
mum
3 JJ
2.9
Sus VPD
i u ai
Disordered
Phonology/dyspraxia
Sensitive to loud
noises
4 CE
2.8
Sus VPD
i u ɜ ɔ ʌ ei ai i
o əʊ aʊ
Dyspraxia/disordered
speech
Grommets ongoing
hearing monitoring
5 AM
3;6
Susp VPD
Disordered speech
OME
6 MT
3.4
CP+Susp
VPD
ɔ ɒ
Delayed language
and disordered
speech
2x grommets
7 HT
3.6
SMCP+VP
D
i
Dyspraxia
Flat tymps
8 BT
4.4
Susp VPD
ɪ (weak
syllable)
Dyspraxia
OME
9 CS
2.10
CP+ Susp
VPD
ɪ ə
Delayed
None
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Therapy eliminated syllabic nasals in 8/9
cases.
3/9 prolonged therapy
1/9 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.
Auditory perceptual approaches
• Input modelling/vowel bombardment therapy
(e.g. Hope cochlear implant ideas
hope.cochlearamericas.com)
•
•
Audio and Video therapy e.g. lorry reversing
iiii ; u for cow
Headphone use as playback in video therapy
– optimal proximity of sound
•
•
•
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).
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
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Vowel viz
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.
Motor approaches
• Nuffield production and sequencing (Williams
and Stephens 2010).
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PROMPT
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Cued vowels
•
•
Assess consonants and vowels; notice weak
syllables
Hearing levels and complexity of speech
disorder important prognostic factors –
maximise visual and auditory input
•
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
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”.
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Jennie Smith – Specialist SLt Cleft Net East
Anne Harding-Bell Module Co-ordinator,
Human Communication Sciences, University
of Sheffield
•
•
•
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 HardingBell, A. J&R Press (Forthcoming)
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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
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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
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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),19-28
Ferdos,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.