Speech-Language Pathology



Speech-Language Pathology


Aren Francis

Sabrina Barr

Gady Har-El



The field of speech-language pathology encompasses a broad scope of practice that includes the evaluation and management of speech, language, voice, and oropharyngeal swallowing disorders that affect children and adults. This chapter describes the different types of disorders that affect speech, language, and swallowing function and highlights indications for referral to a speech-language pathologist.


PEDIATRIC SPEECH-LANGUAGE DISORDERS

Assessment of speech and language disorders among children is based on knowledge of normal speech and language development. To determine when a referral to a speech-language pathologist is indicated, the physician must first have an understanding of what is to be expected at specific ages.

Figure 28-1 outlines the ages at which children are expected to produce correct consonant phonemes. Table 28-1 outlines expected timeframes for the acquisition of receptive and expressive language skills. Referral to a speech-language pathologist should be considered when a child is not developing speech and language within the timeframes outlined in Fig. 28-1 and Table 28-1 or when atypical behaviors are present. Atypical behaviors may include echolalia, reduced auditory attention to language, and behavioral problems that appear to stem from a child’s inability to communicate wants and needs.

Children with a history of hearing loss, cleft palate, cerebral palsy, or neurologic disorders are at risk for impaired speech and language development and should be referred early in development if a problem is suspected. Stuttering, which is interruption in the normal rhythm of speech because of involuntary repetition, prolongation, and arrest of sound, also may warrant referral to a speech-language pathologist. Many children go through a period of normal developmental dysfluency between the ages of 3 and 5 years. However, a child who has a period of dysfluency that lasts more than 6 months or who demonstrates secondary characteristics such as facial grimacing, eye blinking, or struggling behaviors should be referred for evaluation.


ADULT NEUROGENIC SPEECH AND LANGUAGE DISORDERS

Stroke, trauma, neoplasms, infections, and acquired diseases such as myasthenia gravis, multiple sclerosis, amyotrophic lateral sclerosis, Parkinson’s disease, and Huntington’s disease can affect the nervous system and cause speech and language disorders. Patients with these diseases may have dysarthria, which affects voice and articulation, apraxia of speech, which results in impaired volitional control of articulation and prosody, and aphasia, which can affect a person’s ability to formulate, retrieve, and decode language. These speech and language disorders necessitate early evaluation and treatment. An important
aspect of treatment is patient and family education to aid in understanding the disorder and finding ways to cope with impaired communication.






FIG. 28-1. Average age estimates and upper age limits of customary consonant production. The solid bar corresponding to each sound starts at the median age of customary articulation; it stops at the age level at which 90% of all children are customarily producing the sound. Adapted from Sander E. When are speech sounds learned? J Speech Hear Disord 1972;37:2, with permission.


SPEECH DISORDERS CAUSED BY HEAD AND NECK CANCER

Surgical resection for cancer of the lips, tongue, mandible, or larynx affects speech and voice production in varying degrees depending on the extent of tissue resected, degree of nerve damage, and amount of radiation needed after the operation. Along with these anatomic issues, the patient’s general medical, neurological, and mental health will affect speech outcomes. Speech-language pathologists often see patients before surgical treatment to provide counseling on the possible effect of the operation on speech and to provide options for communication after the operation.










TABLE 28-1. Expected time frames for the acquisition of receptive and expressive language skills







































Age

Hearing

Communication


Birth-3 months

Alert to speech

Cries differently for different needs

Recognizes parent’s voice, and quiets if crying


Smiles when spoken to

Responds to human voice which usually has a quieting effect

Startles or awakens in response to loud noises

Makes guttural or throaty sounds (cooing, gooing)


Age 4-6 months

Recognizes changes in tone of voice


Notices toys that make noise


Looks around for the source of new sounds: barking, doorbell, voices

Makes babbling sounds that are more speechlike, and have different sounds (p, b, m)


Tells by sound or gesture when he or she wants someone to do something again


Age 7 months-1 year

Listens when spoken to


Turns upon hearing his or her name

Recognizes words for common objects


Follows simple instructions


Uses jargon. Has one or two words


Points to one or two body parts named


Age 18 months

Imitates the speech of others with correct vowel sounds and number of syllables

Follows one-step commands


Has a vocabulary of 50 words


Starts to combine two words to a phrase


Age 2-3 years

Responds when someone calls from another room


Listens to the television at the same loudness as other family members


Understands in presence of background noise

Follows two-step directions


Uses two- to three-word sentences


Produces sounds: p, b, m, n, h, w


Produces speech, 80% of which is intelligible to strangers


Has a vocabulary of 800-1,000 words by 3 years of age


Age 3-4 years

Responds when someone calls from another room


Listens to television at same volume as other family members


Understands in presence of background noise

Understands who, where, and what questions


Creates three- to five-word sentences


Produces sounds: p, b, m, n, h, w, k, g, d, f, y


Has approximately a 1,500-word vocabulary by 4 years of age

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Aug 2, 2016 | Posted by in OTOLARYNGOLOGY | Comments Off on Speech-Language Pathology

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