CMSD 5050 Glen Nowell Lecture 11 Articulation Disorders 2024 Slides PDF

EVALUATION AND TREATMENT OF ARTICULATORY AND RESONANCE DISORDERS Ferrand Chapter 7 Glen Nowell, SLP-Reg CMSD 5050 Speech Science November 29, 2024  PLAN Describe instrumental measures that augment perceptual evaluation Comp...

EVALUATION AND TREATMENT OF ARTICULATORY AND RESONANCE DISORDERS Ferrand Chapter 7 Glen Nowell, SLP-Reg CMSD 5050 Speech Science November 29, 2024  PLAN Describe instrumental measures that augment perceptual evaluation Compare acoustic and kinematic measures used in Ax and Tx of of clients with a variety of artic and resonance disorders Understand velopharyngeal function and how to measure and treat resonance disorders of structural or neurological etiology  INTELLIGIBILITY The ease with which a listener can understand a speaker Influenced by: degree of articulatory precision Rate of speech Length of utterance Familiarity and predictability of word use Listener’s experience with speaker’s speech pattern (e.g., getting used to accent)  HOW DO WE MEASURE INTELLIGIBILITY Scaling procedures: rating scales of intelligibility Identification tasks: transcribe words or sentences from a list Goal: How effectively do they communicate? Change over time? Limitation: no detail about underlying articulatory movement or pattern (kinematic information)  ULTRASOUND High frequency sound waves (above 1 MHz) that have very short wavelengths Ultrasound works on the principle of reflection. Density affects the reflection. Can see structures and their movement Transducer sends AND receives soundwaves (echo) Gathers data at least 20 times per second Cross section of patient formed line by line by Transducer. ULTRASOUND FOR ARTICULATION  ELECTROPALATOGRAPHY A thin acrylic plate formed to hard palate and teeth is lined with surface electrodes. A ground is strapped to wrist and tiny undetectable electrical signals are sent when the tongue makes contact. Visual display (realtime) shows where the tongue was against the palate when producing different sounds. ELECTROPALATOGRAPHY  GLOSSOMETRY Visualizes tongue shape and position, to give info on vowel patterns. Pseudopalate is fitted, and it contains an array of LED photosensors. Measures distance between sensors and tongue in 10 msec intervals.  MAGNETIC RESONANCE IMAGING Water molecules in the body spin randomly. Superpowerful magnets align the hydrogen in the body in parallel the with the electromagnetic field. A brief radiofrequency hits them, and causes resonance, increasing the proton’s energy. When the radiofrequency is turned off, the molecules randomize and relax, releasing the energy as radio waves. This is detected and measured. Different tissue densities and amount of water in different tissues creates different amplitudes and relaxation times. This is measured and an image is constructed. Safe and non-invasive. NO METAL PLEASE!  ELECTROMAGNETIC ARTICULOGRAPHY Wear a helmet with electromagnetic coils. Glue receiver coils (sensors) to articulators of interest. The movement pattern of articulators are displayed on a screen in 3D animation. Safe and non-invasive MAGNETIC RESONANCE IMAGING MRI OF RESPIRATION  QUICK DEFINITION OF CONSONANTS Stops (aka Plosives): temporarily blocks air, usually released with a burst /p, b/ etc. Fricatives: turbulence from severe narrowing/constriction of air flow /s, z/ etc. Affricates: combine properties of stops and fricatives (a stop released to frication) (as in the start and end of the words Church (voiceless palatal affricate) and Judge (voiced palatal affricate). These can be voiced or unvoiced. Wow, this is good information to know.  CONSONANTS 1. Voicing (voiced or unvoiced) 2. Placement (alveolar, interdental, labiodental, palatal, velar, pharyngeal, glottal) 3. Manner (stop, fricative, affricate) They are written in that order A /s/ is an “unvoiced alveolar fricative”. A /g/ is a “voiced velar stop” or “voiced velar plosive” Wow, Glen, these seem really important for a lovely career as a communication expert.  AX AND TX OF COMM DIS INVOLVING ARTIC AND RESONATION AX: assessment; tx: treatment Dysarthria: of speech production disorders where the speech musculature is weak, paralyzed or uncontrolled. Different neurological disorders can cause reduced articulatory precision, altered range of movement (too much or too little or variable), timing of articulators, muscle strength and endurance. Apraxia: problem sequencing the articulatory movements for speech. smoothening of movement: cerebellum  ARTICULATORY FEATURES FOR DYSARTHRIA Amyotrophic lateral sclerosis Group with 80-85% intelligibility had measurably longer and more variable vowel and consonant durations (slow, weak tongue movements). Measuring changes of tongue movement speed may be early indicator, even before speech is noticed as distorted. Typical speech rate: 5 syllables/sec. Dysarthric speech rate: 3.1 syllables per sec.  VOWEL FORMANT ANALYSIS FOR DYSARTHRIA F1/F2 plots for vowel spaces give inferences about tongue movements Dysarthric speakers often have reduced vowel space with more neutral pattern for corner vowels (slower, weaker), or cluster in a specific space (reduced tongue mobility could do that). Think “rounding the bases.” If you can’t get to the place of articulation and maintain your rate of speech, you might get most of the way there and then head toward the next point of articulation. By being less precise, you may become faster. E.g., Parkinson’s Disease and its characteristic hypokinetic dysarthria. BIG recommendation to dysarthric speakers: SLOW DOWN.  VOWEL FORMANT ANALYSIS FOR DYSARTHRIA Can track improvement over time (e.g., closed head injury, Ziegler et al, 1993) Can show between group differences (e.g., Turner et al, 1995). Healthy normal had wider vowel space in normal speech and more precision when slow Clients with ALS had smaller space which did not improve with slower rate (runs counter to general recommendation to slow down…) F1/F2 ratios are useful—different vocal tract sizes and shapes mean ratio is more important than the numbers. VAI (Vowel Articulation index) divides high formants by low formant frequencies to derive the ratio. Sensitive to changes in mild dysarthria. F1a+F2i /F1i+ F1u +F2a +F2u FCR (Formant Centralization ratio) is the inverse of the VAI.  F2 TRANSITIONS F2 is related to tongue Frontness (direct) The slope of the formant during transition is measured, so is duration of it (msec) “Slope index” measured in Hz/msec Slope is change of 20-30 Hz (or greater) over 20 msec Flat slope means slower tongue movement with less range Can be measured in early subclinical cases (intelligibility still normal) Normal cis female slope index 3.76-5.4 Hz/msec 2.5 Hz/msec divided good vs poor intelligibility in speakers with dysarthria  SPECTRAL ANALYSIS OF CONSONANTS Dysarthria can affect production of stops, fricatives and affricates. Differentiating alveolar and palatal fricatives require precise tongue shape and position. E.g., dysarthric production of /s/ may have lower frequency peaks (more posterior position), wider or longer constriction, reduced flow, or any combo. Poor closure of /t/ makes it sound like a fricative /s/. No silent gap, no burst release. Voicing of voiceless consonants is also a problem, as is nasalance.  PARKINSON’S Hypokinetic (not enough movement) dysarthria produces impression of accelerated and accelerating speech rate due to rigidity and articulatory undershoot. Less complete stopping sound production during stop closures (frication), quicker transition between consonants and vowels. Speech rate is not actually faster than normal rate. However, articulatory undershoot is characteristic of normal speakers when asked to speak extra fast. The articulatory undershoot of people with Parkinson’s gives the impression of faster than normal speech.  KINEMATIC MEASURES Electropalatography (EPG) gives info on spatial and timing characteristics of artic. Electropalatography studies: 3 patterns characteristic of dysarthric speech Articulatory undershoot (not enough tongue contact with palate) Articulatory overshoot (too much contact) Posterior tongue placement of the tongue Collectively give impression of artic imprecision, phoneme prolongation, reduced speech rate For Parkinson’s: reduced tongue force, poor coordination of artic movements Apraxia: reduced independence of tongue mov’t, overshoot, distorted patterns of contact, impaired coarticulation  ELECTROMAGNETIC ARTICULOGRAPHY (EMA) Monitoring coordination of tongue tip, tongue back and jaw movements showed unique disturbances of patterns, supporting need for individualized interventions to optimize therapeutic outcomes among speakers with dysarthria. EMA has been used for visual biofeedback for clients with dysarthria and apraxia. Generalization to different (non-test) words and maintenance of gains.  ELECTROMAGNETIC ARTICULOGRAPHY Wear a helmet with electromagnetic coils. Glue receiver coils (sensors) to articulators of interest. The movement pattern of articulators are displayed on a screen in 3D animation. Safe and non-invasive  HEARING IMPAIRMENT Deaf or hearing-impaired individuals often have difficulty with articulation. Typical development requires exposure to the target sounds, production and monitoring/refinement through auditory monitoring of the production. Intelligibility can be mildly to severely reduced. Often called “deaf speech.” Vowels and consonants can be difficult, and suprasegmentals can be affected. Coarticulation may be affected. Most frequent segmental errors are vowels (especially neutralization of vowels). F1/F2 can be reduced in horizontal and vertical movements. Consonant omissions, substitutions in voicing, manner and place of articulation Suprasegmental: inappropriate, excessive or insufficient variations in Fo and intensity.  HEARING IMPAIRMENT Acoustic analysis: alveolar and velar stops are often too far back in vocal tract. Playing real time pitch-type programs can help kids improve suprasegmentals like intonational contour for declarative/interrogative contrast and naturalness of melody and stress. Vowel precision has biggest impact on intelligibility, followed by consonants and only fine-tuning change with suprasegmentals. Spectrographic analysis gives more feedback than speech reading cues. Useful for training speech sounds including vowels and consonants.  HEARING IMPAIRMENT Electropalatograpy (EPG) and glossometry provide direct info about articulator movements. Valuable biofeedback of even small changes of articulation. Glossometry shows vertical position of tongue, can be used to shape and improve vowel production.  COCHLEAR IMPLANT Hearing aids amplify sound and direct it to the inner ear. Mic, processor, amplifier, loudspeaker. Cochlear implant: directly stimulates the auditory nerve with a receiver/stimulator and electrical array implanted in a cochlea. External part worn behind the ear, has a mic, speech processor, transmitter and battery. https://upload.wikimedia.org/wikipedia/com mons/thumb/5/50/Blausen_0244_CochlearImp lant_01.png/420px- Blausen_0244_CochlearImplant_01.png  COCHLEAR IMPLANTATION CI provides auditory feedback that is lacking through normal channels. Speech therapy is still necessary to improve motor patterns for speech sounds. Acoustic and kinematic measures help before and after CI. Early implantation improves vowel accuracy. Children with profound hearing loss and HA had smaller vowel space than kids with CI, which improved after 6-12 months post implantation, closer but not equal to kids with typical hearing. Electropalatography can help with artic including velars, which can be trickier (no visual feedback)  SPEECH SOUND DISORDERS Delayed acquisition of developmental speech sounds (reduced intelligibility) Neurological, structural (e.g., cleft palate), syndromes, hearing impairment, idiopathic.  ARTICULATORY/PHONATORY DISORDERS Substitutions (fink for think) Distortions (lateral lisp) Omissions (eel for feel) (initial consonant deletion is rather rare) Phonological Processes velar fronting-- ting for king Cluster reduction-- ting for string Final consonant deletion-- ca for cat Common in kids, most grow out of them. Some are typical, some are atypical. Impact on intelligibility varies. Subtle marking to distinguish /k/ from /t/ may be measurable but not perceivable.  ACOUSTIC ANALYSIS FOR PHONOLOGICAL PROCESSES Acoustic differences (marked but not different enough for ear to distinguish) can predict resolution. Phonetic differences in place of articulation (alveolar vs palatal) or voicing (voice onset time) can be measured  VOICE ONSET TIME VOT reflects the time elapsed after the stop burst when voice begins. Voiced less than 30 msec after. Voiceless tend to be 30-75 msec. Voiced sounds often have voice start before release of stop. (/b/ as in “beak”) Voiceless stops can be aspirated (audible breath release) or unaspirated (no audible breath release) Aspirated stops are usually at the start of a word, and have a longer delay before voice begins after the burst release (/p/ as in “peak”) Unaspirated stops can be in a consonant cluster like /sp/ from “speak” VOICE ONSET TIME  VOICE ONSET TIME https://home.cc.umanitoba.ca/~krussll/phonetics/narrower/aspiration.html  KINEMATIC ANALYSIS FOR SSD Ultrasound can be used for /r/ correction. Model it, show images, have child practice shape silently, introduce voice. Improvement can occur after a few hours of practice. /r/ uses a lowered F3 visible on spectrogram, visible after training of sublingual ultrasound during therapy (child can see tongue shape, improve it). Electropalatography: useful to show and correct velar fronting  CLEFT PALATE Even after cleft palate repair, velopharyngeal problems can continue (resonance and articulatory errors). Pressure consonants (stops, plosives and affricates) can be affected. Compensatory strategies: increase tongue to palate contact to obstruct cleft, backing of alveolars, velar fronting, stopping of fricatives, other abnormal patterns of artic and voice onset. EPG has shown double articulations for stops (tip and blade may not move separately from rest of tongue body) Abnormal patterns may require EPG to learn new placements and patterns.  STUTTERING Artic and/or phonological difficulties as well as dysfluency. Longer VOTs and vowels and longer movement durations, more time between articulatory and phonatory events. F2 transition rate (FTR) indicates tongue speed moving from one location to another. FTR is slower in children who stutter. Articulatory force can be too strong: focus on light easy contacts. Softer and slower production can help reduce muscle activity (reduce tension and blocking).  RESONANCE PROBLEMS Can be related to Hyponasality: reduced problem with the Hypernasality: air and sound escaping structure of hard or soft sound escapes through through the nose when palate or nasal cavity, the nose when it it should, like enlarged or function of soft shouldn’t. adenoid pad. palate. Cul-de-sac resonance: sound goes in, but has to turn back Nasal emission: air due to a blockage near the front, like a deviated septum or escaping through the a nasal polyp (nasal cul de sac) or large palatine tonsils nasal cavity (pharyngeal cul de sac). Or Shaggy (aryepiglottic cul de sac)  RESONANCE PROBLEMS Hypernasality is the most common issue we’ll help manage. Poor Velopharyngeal closure: weak consonants, altered resonance. Compensation: articulation moves place to a spot that can still seal: velar or pharyngeal or glottal. (commonly glottal stops, pharyngeal stops or fricatives). PERCEPTUAL EVALUATION OF RESONANCE 1. Listen 2. See-scape: nasal bulb attaches to tube going into a cylinder with a float. Nasal air makes float rise. Problem: KIDS LIKE TO SEE IT GO UP! STAYING DOWN IS BORING! 3. Plastic straw or tube (put one end at nostril, other points to ear). tool: See-Scape move ball when air comes out of nose not a great tool for kids since they’ll want to make the ball move  NASOPHARYNGOSCOPY Put scope into nasal pharynx. Watch Velopharyngeal port, understand movement and closure pattern. Different interactions between velum, lateral pharyngeal wall and posterior pharyngeal wall for different people. Failure to elevate velum: problem. See bubbles when doing oral sounds like /s/: evidence of poor seal.  VPI ASSESSMENT (MAYO CLINIC) https://youtu.be/BTZ7bpC5b68?t=106  FANTASTIC LARYNGEAL ANATOMY REVIEW DIZZY GILLESPIE, NOT USING BUCCINATOR  VIDEOS https://youtu.be/BTZ7bpC5b68?t=106 https://youtu.be/BTZ7bpC5b68?t=106 https://www.youtube.com/watch?v=JIEogUl4YmM&t=29 s https://www.youtube.com/watch?v=wj7iM0BCWMQ&t= 18s https://www.youtube.com/watch?v=6oIejoZ17j0&t=13s https://www.youtube.com/watch?v=e_3w3rReSlA https://www.youtube.com/watch?v=1pdrMCuxDf4 https://www.youtube.com/watch?v=ql9TLUr7G78  ARTICLE Statistical Models of F2 Slope in Relation to Severity of Dysarthria. Yunjung Kim,a,* Gary Weismer,b Raymond D. Kent,b and Joseph R. Duffyc. Folia Phoniatr Logop. 2009 Dec; 61(6): 329–335.