Unit 4: Speech problems in children with hearing impairment

4.1   Speech problems: Articulation errors, Voice problems, Errors in supra-segmental

4.2   Speech intelligibility

4.3   Evaluation of speech

4.4   Evaluation of speech in terms of voice, articulation and Supra-segmental

4.5   Profiling in speech of the students in classrooms

 

4.1   Speech problems: Articulation errors, Voice problems, Errors in supra-segmental

 

 

Speech sound disorders can be organic or functional in nature. Organic speech sound disorders result from an underlying motor/neurological, structural, or sensory/perceptual cause. Functional speech sound disorders are idiopathic they have no known cause. See figure below.

Articulation is the process humans go through to produce sounds, syllables and words. A child with articulation disorder may be unable to produce certain sounds or form particular sounds incorrectly. It can make the child s speech hard to understand and affect socialization and learning.

Articulation disorder is a common condition when your child can t make specific sounds. For example, they may always replace r with w or th with s. The disorder isn t related to any issues with their brain, mouth or hearing. 

A child with articulation disorder may be difficult to understand. They exhibit one or more of four types of articulation errors:

• Addition: Adding sounds or syllables to words that don t belong there (for example, puh-lay instead of play ).
• Distortion: Changing a sound, which might seem like a lisp (when s sounds like th ).
• Omission: Leaving certain sounds out of their speech altogether (for example, never using sc in school or scratch ).
• Substitution: Always substituting one sound for another (for example, using s instead of th or w in place of r ).

There are five ways of manner of articulation, which describe the way in which a sound is produced:

      Plosive: When airflow is stopped and then released, producing a sound. Examples include /p/, /b/, /t/, /d/, /k/, and /g/.

      Nasal: When airflow passes through the nasal cavity. Examples include /m/, /n/, and /ng/.

      Fricative: When airflow is constricted, producing a hissing sound. Examples include /f/, /v/, /s/, /z/, /sh/, and /h/.

      Affricate: A combination of a plosive and a fricative sound. Examples include /ch/ and /j/.

      Approximant: When the articulators are close but not touching, producing a sound. Examples include /r/ and /l/.

Functional speech sound disorders include those related to the motor production of speech sounds and those related to the linguistic aspects of speech production. Historically, these disorders are referred to as articulation disorders and phonological disorders, respectively. Articulation disorders focus on errors (e.g., distortions and substitutions) in production of individual speech sounds. Phonological disorders focus on predictable, rule-based errors (e.g., fronting, stopping, and final consonant deletion) that affect more than one sound. It is often difficult to cleanly differentiate between articulation and phonological disorders; therefore, many researchers and clinicians prefer to use the broader term, "speech sound disorder," when referring to speech errors of unknown cause.

Voice problems

 

The human voice is a sound generated in the larynx and further modified by resonance organs including the throat, nasal cavity, and sinuses. The basic tone generated in the glottis is characterized by specific physical features. In the upper level of the vocal tract, the voice receives unique subjective and individual features that depend upon the structure of the larynx and facial part of the skull. Measurable, physical voice parameters correspond well with subjective features. Thus, physical voice features such as frequency, amplitude, and spectral structure are perceptively represented by pitch, loudness, and timbre. Thus, the voice is a source of information and conveys human emotions.

The voice appears in newborns immediately after birth as a reflex. Voice continues to develop in further stages of life and, together with the development of speech, voice becomes a useful tool of interpersonal communication.

Hearing loss can impair voce production, causing social, educational, and speech limitations, with specific deviation of the communication related to speech and voice.

Voice problems in individuals with this impairment are directly related to its type and severity, age, gender, and type of hearing device used. While individuals with mild and moderate hearing loss can only present problems with resonance, severely impaired individuals may lack intensity and frequency control, among other alterations. The commonly found vocal deviations include strain, breathiness, roughness, monotone, absence of rhythm, unpleasant quality, hoarseness, vocal fatigue, high pitch, reduced volume, loudness with excessive variation, unbalanced resonance, altered breathing pattern, brusque vocal attack, and imprecise articulation. These characteristics are justified by the incapability of the deaf to control their vocal performance due to the lack of auditory monitoring of their own voice, caused by the hearing loss. Hence, the development of an intelligible speech with a good quality of voice on the hearing impaired is a challenge, despite the sophisticated technological advances of hearing aids, cochlear implants and other implantable devices.

A voice disorder occurs when voice quality, pitch, and loudness differ or are inappropriate for an individual s age, gender, cultural background, or geographic location. A voice disorder is present when an individual expresses concern about having an abnormal voice that does not meet daily needs even if others do not perceive it as different or deviant.

For the purposes of this document, voice disorders are categorized as follows:

• Organic physiological voice disorders that result from alterations in respiratory, laryngeal, or vocal tract mechanisms.
• Structural organic voice disorders that result from physical changes in the vocal mechanism, such as
• alterations in vocal fold tissues (e.g., edema or vocal nodules) and/or
• structural changes in the larynx due to aging.
• Neurogenic organic voice disorders that result from problems with the central or peripheral nervous system innervation to the larynx that affect functioning of the vocal mechanism, such as
• vocal tremor,
• spasmodic dysphonia, or
• vocal fold paralysis.
• Functional voice disorders that result from inefficient use of the vocal mechanism when the physical structure is normal, such as
• vocal fatigue,
• muscle tension dysphonia or aphonia,
• diplophonia, or
• ventricular phonation.

Voice characteristic of individuals with hearing loss according to type and severity of hearing loss, hearing loss onset, and treatment of choice.

	HL characteristics	Voice characteristics
Type	Conductive	Reduced loudness
	Sensorineural	High fundamental frequency (f0), f0 within normal standards, normal jitter, normal shimmer, high variation of amplitude, and f0 instability
	Mixed	Not reported
Severity	Mild to moderate	Resonance disorder
	Severe to profound	High f0, instability
HL (Hearing loss) onset	Prelingual	Hoarseness, breathiness, strain, high f0, high variability in f0, excessive intonation, monotone, excessive pitch variation, altered speech rate, increased loudness, loudness either to soft or too loud, resonance irregularity, instability
	Postlingual	Abnormal intonation, high pitch/f0, altered speech rate, nasality, loudness deviation, roughness, strain, instability, high jitter, high shimmer high noise to harmonic ratio
Treatment	Hearing aid	High f0, high pitch, f0 within normal standards, normal jitter, normal shimmer, high jitter, high shimmer, high variation of amplitude and f0 , strain, instability
	Cochlear implant	High f0 , normal f0, high pitch, variation of amplitude and fundamental frequency, high jitter and shimmer, instability, strain, significant overall severity of voice quality

Errors in suprasegmentals

 

The hearing impaired children stop or regress in their vocal behaviour in the age at which suprasegmental production gets differentiated in a normal child. Generally speaking, suprasegmental production precedes segmental production in a normal child. But, the hearing impaired may start imitating both the aspects at the same time during the speech training sessions. As Ling (1976) suggests, if the residual hearing in low frequencies is good, then the sequence of development of segmental and suprasegmental features may be normal.

Errors in suprasegmental features of speech (such as intonation, stress, pitch, and duration) are commonly observed in individuals with hearing impairment due to their reduced ability to hear and process these features of speech. Suprasegmentals play a key role in conveying meaning, emotional tone, emphasis, and rhythm in speech, and any difficulty in perceiving or producing these aspects can significantly impact the quality and clarity of speech.

Key Suprasegmental Features and Associated Errors in Hearing-Impaired Speech

1.     Intonation refers to the rise and fall of the voice pitch during speech, which helps convey meaning, emotion, and sentence type (e.g., whether a statement, question, or exclamation is being made).

Errors:

      Flat Intonation: Hearing-impaired individuals often fail to vary their pitch as needed, leading to a "monotone" speech pattern. This can make their speech sound robotic, dispassionate, or difficult to understand.

      Inappropriate Pitch Contours: Without the ability to hear the appropriate pitch patterns in speech, individuals may produce unnatural pitch contours, such as using a rising intonation for statements or a falling intonation for questions, which can confuse listeners.

2.     Stress refers to the emphasis placed on certain syllables or words in a sentence. Stress patterns are important for distinguishing between different meanings (e.g., "record" as a noun vs. "record" as a verb).

Errors:

      Misplaced Stress: Hearing-impaired speakers may have difficulty placing stress on the correct syllable or word, leading to confusion in speech. For example, they may stress the wrong syllable in a word ("PRESent" instead of "preSENT") or fail to stress content words (nouns and verbs) in a sentence.

      Lack of Word Stress: In some cases, words may be spoken with equal stress on all syllables, making speech sound unnatural and harder to understand.

      Reduced Stress Patterns: In more severe cases of hearing loss, individuals may struggle to produce varying levels of stress, causing their speech to sound flat and lacking emphasis, which reduces the clarity of the message.

3.     Pitch refers to the perceived frequency of a sound, with higher pitches being perceived as "high" and lower pitches as "low." It is a key element of intonation and affects the emotional tone and expressiveness of speech.

Errors:

      Limited Pitch Range: Hearing-impaired speakers may have a restricted pitch range, using only a narrow range of high or low pitches, resulting in speech that lacks emotional expressiveness and variability.

      Inappropriate Pitch Levels: Some hearing-impaired individuals may produce speech that is too high-pitched or too low-pitched for the context, making their speech sound unusual or difficult to interpret.

      Monotony: With a lack of access to normal pitch variations, hearing-impaired individuals may not adjust their pitch to match the emotional context of their speech, resulting in speech that is emotionally flat or disconnected from the intended meaning.

4.     Duration refers to the length of time a sound or syllable is held during speech. Proper duration is essential for maintaining the rhythm and flow of speech and distinguishing between different meanings (e.g., the difference between "bit" and "beat").

Errors:

      Inconsistent Duration: Hearing-impaired individuals may struggle to produce speech sounds with the correct duration. For example, they might make vowels too short or hold consonants too long, leading to unnatural-sounding speech.

      Inappropriate Pauses: Due to challenges in processing auditory input, individuals may place pauses in odd locations within a sentence, breaking up the flow of speech inappropriately.

      Syllable Duration: Sometimes, hearing-impaired individuals may fail to maintain the appropriate rhythm in their speech, either elongating or shortening syllables in a way that makes speech less intelligible.

5.     Speech Rhythm refers to the pattern of stressed and unstressed syllables in speech. It contributes to the natural flow of speech and the conveyance of meaning.

Errors:

      Disturbed Rhythm: Hearing-impaired individuals may struggle to maintain a consistent rhythm in their speech, leading to a choppy or disjointed quality.

      Reduced Speed or Delayed Responses: In some cases, hearing loss can lead to slower speech or delayed responses, which can impact the natural flow of conversation.

      Difficulty with Speech Timing: There may be difficulty in synchronizing speech timing, such as the pacing of words or syllables. This can lead to overly rapid speech or speech that is too slow, affecting overall comprehension.

Factors Contributing to Suprasegmental Errors in Hearing-Impaired Speech

1.     Reduced Auditory Feedback: One of the most significant challenges for individuals with hearing impairment is the lack of auditory feedback. Auditory feedback is essential for self-monitoring speech production, especially for suprasegmental features like pitch, stress, and intonation. Without the ability to hear their own speech or hear others clearly, they may have difficulty adjusting these aspects of speech in real-time.

2.     Hearing Aid or Cochlear Implant Use: While hearing aids and cochlear implants can provide some access to sound, they may not fully replicate the natural experience of hearing. These devices may not offer clear auditory feedback for the full range of frequencies, which can affect the person s ability to produce speech with appropriate suprasegmental features.

3.     Delayed Speech and Language Development: Children with hearing impairment often experience delays in their overall language development, which can affect both segmental (consonants and vowels) and suprasegmental aspects of speech. These delays can hinder their ability to acquire natural speech patterns such as intonation, rhythm, and stress.

4.     Cognitive and Processing Factors: Cognitive factors, such as attention, memory, and processing speed, may also influence a hearing-impaired individual's ability to produce and perceive suprasegmental features. For example, difficulty processing multiple speech cues at once may affect their ability to correctly place stress or adjust pitch.

5.     Visual and Tactile Cues: Many individuals with hearing impairment rely on lip-reading, sign language, or other non-auditory cues to compensate for their hearing loss. While these strategies are valuable for communication, they may not always provide sufficient information about the suprasegmental features of speech, leading to errors in pitch, stress, and intonation.

 

Suprasegmental features such as intonation, stress, pitch, and rhythm play an important role in natural, intelligible speech. For individuals with hearing impairment, errors in these features are common due to reduced access to auditory feedback and challenges in language acquisition. However, with early intervention, appropriate use of hearing aids or cochlear implants, and focused speech therapy, it is possible to improve these aspects of speech, allowing individuals to communicate more effectively and expressively.

 

4.2   Speech intelligibility

 

Speech intelligibility is that aspect of speech-language output that allows a listener to understand what a speaker is saying . Highly intelligible speech allows na ve listeners to understand most of the child s speech at first introduction . As intelligibility decreases, listeners experience greater difficulty in understanding what they hear, until just a few--or even no--words are recognized. Research completed during the 1960s 1980s revealed that the speech of children with severe to profound hearing losses was approximately 20% intelligible on average. Clearly, low levels of intelligibility can lead to substantial communication difficulties at home, in school, and in other everyday situations.

Speech intelligibility can be defined as how clearly a person speaks so that his or her speech is comprehensible to a listener. Reduced speech intelligibility leads to misunderstanding, frustration, and loss of interest by communication partners. As a result, communication decreases or remains at a low level. Thus, to improve the quality of life of adults with HI, it is essential to enable them to make themselves understood. Impairment of speech production is among the most commonly reported difficulties in children, adolescents and adults with HI. The deficiencies are not resolved when growing up and speech intelligibility remains a problem throughout life.

In individuals with speech impairments, intelligibility is often reduced due to a variety of factors, including physical speech production challenges, hearing impairments, or neurological conditions.

Factors Affecting Speech Intelligibility

Several factors can affect how intelligible someone's speech is to a listener. These factors are generally classified into internal and external influences.

1. Internal Factors: These factors are inherent to the speaker and directly related to how they produce speech.

• Articulation: The ability to form clear speech sounds by controlling the vocal tract, lips, teeth, and tongue. Misarticulations such as substitutions, omissions, and distortions can greatly reduce intelligibility.
• Phonological Patterns: Problems with the sound system of language can lead to patterns of errors, such as incorrect sound combinations, which affect intelligibility.
• Voice Quality: Changes in vocal quality, such as hoarseness, breathiness, or nasality, can interfere with the clarity of speech sounds and affect intelligibility.
• Fluency: Disruptions in the flow of speech, such as stuttering or excessive pauses, can make speech more difficult to understand.
• Speech Rate: Speaking too quickly or too slowly can affect intelligibility. Fast speech may be unclear, while overly slow speech may be harder to follow and may disrupt the natural rhythm.
• Speech Breathing: Proper breath control and timing are essential for maintaining intelligible speech. Inadequate breath support or breathy speech can reduce intelligibility.
• Suprasegmental Features: Errors in intonation, stress, and pitch (suprasegmentals) can distort the meaning of sentences and phrases, leading to reduced intelligibility.

2. External Factors: These are factors that are external to the speaker and affect the listener s ability to understand speech.

• Listener s Familiarity: A listener s experience with the speaker s speech patterns or dialect can influence how well they understand the speaker. A familiar listener might understand a speaker more easily, even if the speech is less intelligible.
• Environmental Noise: Background noise, competing sounds, or a noisy environment can make it difficult for listeners to focus on and understand speech, even if the speaker's speech is clear.
• Acoustic Conditions: The quality of the acoustics in the environment, such as echoes, room size, and sound transmission, can also influence speech intelligibility.
• Listener's Hearing Ability: A listener s hearing ability or use of hearing aids can affect their ability to understand speech, especially in noisy environments or when the speech contains distortions.

Measuring Speech Intelligibility

Speech intelligibility can be measured in a variety of ways, ranging from subjective judgment to more objective, standardized methods. Some common methods include:

1. Subjective Measures (Listener Ratings)

• Intelligibility Scales: These are scales used by listeners to rate the clarity of speech on a subjective level. For example, a listener may rate how easy it is to understand a speaker s words on a scale from 0 to 5, where 0 means unintelligible and 5 means completely intelligible.
• Speech-Language Pathologist (SLP) Evaluation: A professional may listen to and rate the intelligibility of speech using structured assessments, such as the Speech Intelligibility Rating (SIR) scale, or more informal observations.

2. Objective Measures (Speech Samples and Calculations)

• Word Intelligibility Tests: The speaker may be asked to pronounce a list of words, and listeners rate how many of the words are understood. For example, in a closed-set word intelligibility test, the listener selects the correct word from a set of options.
• Sentence Intelligibility Tests: The speaker is asked to pronounce sentences, and the listener is asked to transcribe the sentence or select it from a list. The percentage of correctly transcribed sentences gives an intelligibility score.
• Phoneme Recognition: Phoneme-level assessments measure how many speech sounds (consonants and vowels) are correctly identified by the listener. This can be used to assess specific areas of articulation that affect intelligibility.
• Automated Speech Recognition (ASR): In some cases, automated systems or software may be used to assess intelligibility by comparing the recorded speech to a model or by using machine learning algorithms to assess how clearly speech is recognized.

Factors Influencing Intelligibility in Hearing-Impaired Individuals

For individuals with hearing impairments, intelligibility is often impacted by the severity and type of hearing loss, as well as the age at which hearing loss occurs. Here are some factors that influence the intelligibility of speech in people with hearing impairments:

1.     Severity of Hearing Loss:

o   Individuals with profound hearing loss may have difficulty hearing and producing sounds, which can significantly reduce their speech intelligibility.

o   Those with mild to moderate hearing loss may have clearer speech, but still struggle with certain speech sounds or suprasegmental features.

2.     Age of Onset of Hearing Loss:

o   Pre-lingual Hearing Loss: Individuals who experience hearing loss before acquiring spoken language (typically before age 3) may have more significant challenges with both segmental and suprasegmental aspects of speech. Intelligibility is often lower due to delays in language development and the lack of auditory feedback.

o   Post-lingual Hearing Loss: Individuals who experience hearing loss after they have acquired speech and language may have relatively higher intelligibility, but they might still struggle with aspects of pitch, stress, and fluency due to the loss of auditory feedback.

3.     Use of Hearing Aids or Cochlear Implants:

o   The effectiveness of hearing aids and cochlear implants plays a significant role in speech intelligibility. These devices can improve access to speech sounds, but they may not provide full auditory feedback, which can still affect the clarity of speech.

4.     Speech Therapy:

o   Early intervention with speech therapy can significantly improve speech intelligibility, especially for children with hearing impairments. Speech therapy targets articulation, fluency, and suprasegmental features, helping the individual improve speech clarity.

5.     Consistency of Auditory Input:

o   Regular exposure to speech, whether through hearing aids, cochlear implants, or visual cues (like lip-reading or sign language), can improve intelligibility over time. Consistency in auditory input during the critical period of language development is particularly important.

Improving Speech Intelligibility in Hearing-Impaired Individuals

Several approaches can help improve speech intelligibility in individuals with hearing impairment:

1.     Hearing Devices: Using hearing aids or cochlear implants can enhance a person s ability to hear speech sounds, which is a critical step toward improving both segmental and suprasegmental features of speech. These devices are especially effective if used early and consistently.

2.     Speech-Language Therapy: Focused therapy can target articulation, fluency, and suprasegmentals. Techniques might include:

o   Auditory Training: Training the person to identify and produce sounds more clearly.

o   Articulation Therapy: Working on specific speech sounds that are difficult to produce.

o   Breathing and Voice Training: Teaching breath control and proper voice use to support intelligible speech.

3.     Sign Language and Bilingual Communication: In some cases, individuals may benefit from learning sign language to supplement or replace speech, especially in cases of profound hearing loss. The use of a bilingual approach (e.g., both spoken and signed language) can provide a more effective means of communication.

4.     Use of Visual Cues: Lip-reading, facial expressions, and gestures can be effective strategies to enhance communication when auditory input is limited. This also helps reinforce the listener's ability to understand speech.

5.     Communication Partner Strategies: Encouraging communication partners to speak clearly, face the individual directly, use gestures, and allow more time for speech can improve the intelligibility of speech for those with hearing impairments.

Speech intelligibility is a critical factor in communication, and many individuals with hearing impairments face challenges in achieving clear and understandable speech. The factors that influence intelligibility range from articulation and voice quality to environmental influences and the type of hearing impairment. Early intervention, including the use of hearing devices, speech therapy, and strategies to enhance communication, can significantly improve speech intelligibility and help individuals with hearing loss engage more effectively in daily communication.

 

 

4.3   Evaluation of speech

 

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It is important to note the distinctions between the terms evaluation and assessment according to IDEA Part C Guidelines. Evaluation means the "procedures used by qualified personnel to determine a child's initial and continuing eligibility..." IDEA (2004), Part B requires that an evaluation be comprehensive and assess all areas of suspected disability. It is important for the clinician to involve other assessment staff as part of the multidisciplinary evaluation team to address educational and/or behavioral concerns for students who are not meeting the grade-level expectations (IDEA, 2004, Section 34 CFR 300.304). 

Speech and language evaluations are invaluable, as they allow us to determine if speech therapy is warranted. They provide clinicians with the information needed to pinpoint a speech and language diagnosis/diagnoses (e.g., expressive language delay, childhood apraxia of speech, etc.) if one or more is appropriate. Additionally, evaluations allow SLPs to gather quantitative and qualitative information on a child s strengths and areas of weakness that inform subsequent treatment and goals. They also provide baseline data on a child s current speech and language skills that can then be used to measure progress and growth with therapy.

Speech evaluation is a process used to assess an individual's speech production, including articulation, fluency, voice quality, and suprasegmental features like pitch, stress, and intonation. The purpose of speech evaluation is to identify any speech disorders, understand their underlying causes, and develop appropriate intervention strategies to improve communication skills. The evaluation process may be conducted by a speech-language pathologist (SLP) or other trained professionals.

Goals of Speech Evaluation

The goals of speech evaluation include:

1.     Identifying Speech Disorders: Detecting difficulties related to articulation, voice, fluency, or language that may be impairing effective communication.

2.     Determining Severity: Understanding how severe the speech disorder is and how it affects the individual's daily life and communication.

3.     Identifying Underlying Causes: Assessing the potential causes of speech difficulties, such as hearing impairment, neurological disorders, developmental delays, or psychological factors.

4.     Guiding Treatment: Creating an individualized treatment plan based on the evaluation results to address specific speech challenges and improve communication skills.

Steps in the Speech Evaluation Process

1.     Case History and Background Information

o   The evaluation typically begins with gathering relevant background information from the individual (or their family) about their medical history, developmental milestones, family history of speech and language disorders, and any previous interventions or therapies.

o   The SLP will ask questions about the individual s speech and language development, hearing history, social environment, educational experience, and any concerns related to speech intelligibility or communication.

2.     Observation of Speech and Communication

o   The clinician may observe the individual's natural speech in a variety of settings, such as during conversation or in structured tasks. Observing how the individual interacts with others helps assess spontaneous speech, fluency, and social communication skills.

3.     Formal Testing

o   Articulation Tests: Standardized tests are often used to assess the accuracy of speech sound production, including the ability to pronounce consonants and vowels correctly. For example, the Goldman-Fristoe Test of Articulation and the Photo Articulation Test are commonly used to assess articulation.

o   Phonological Awareness: For children, an evaluation of their phonological awareness (understanding of sound patterns, rhyme, etc.) is important in assessing speech development.

o   Language Assessments: These tests evaluate receptive and expressive language skills, including vocabulary, grammar, sentence structure, and comprehension. Examples include the Peabody Picture Vocabulary Test (PPVT) or Clinical Evaluation of Language Fundamentals (CELF).

o   Voice Quality Assessments: This may involve listening to the person s voice and using tools like a visipitch (a voice analysis instrument) to measure voice pitch, loudness, resonance, and quality (e.g., hoarseness, breathiness).

o   Fluency Tests: For individuals with fluency disorders (e.g., stuttering), tools like the Stuttering Severity Instrument (SSI) or the Test of Childhood Stuttering may be used to evaluate speech fluency, speech rate, and disfluency behaviors (e.g., repetitions, prolongations, blocks).

o   Speech Intelligibility Tests: These tests measure how clearly the person is able to produce speech. In a typical test, the individual may be asked to read sentences or words aloud, which are then transcribed by a listener to assess how much is understood.

4.     Speech Perception and Auditory Evaluation

o   If a hearing impairment is suspected, the SLP will assess speech perception through various tests. This could include audiometric testing to assess hearing thresholds, speech audiometry, and speech discrimination tasks. Understanding how well a person perceives speech sounds will help guide therapy, especially in the case of hearing loss.

5.     Suprasegmental Evaluation

o   This involves assessing aspects of speech beyond individual sounds, including:

  Intonation: The rise and fall of the voice during speech, which conveys meaning and emotion.

  Stress: The emphasis placed on specific words or syllables.

  Rhythm: The timing of speech, including the rate of speech and the use of pauses.

o   The clinician listens for abnormal patterns in these areas, such as monotonous speech or incorrect stress placement, which may indicate issues with suprasegmentals.

6.     Oral and Motor Examination

o   A thorough examination of the oral and motor structures is conducted to rule out physical causes of speech issues. The clinician may check the lips, teeth, tongue, hard and soft palate, and jaw for any structural abnormalities that could affect speech.

o   The clinician may also assess oral motor skills (coordination of oral muscles) with tasks such as alternating sound production ("pa-pa-pa" or "ta-ta-ta"), as issues with motor control can contribute to articulation or speech fluency problems.

7.     Speech Sample Analysis

o   A speech sample is recorded during conversation or specific speech tasks, such as reading or storytelling. The clinician then analyzes the speech for intelligibility, articulation errors, prosody (intonation, rhythm), and fluency.

o   The analysis may focus on the frequency of speech errors, such as omissions, distortions, substitutions, and repetitions, to determine the severity of the speech disorder.

8.     Collaborative Evaluation

o   In some cases, a team of professionals may be involved in the evaluation, including audiologists, psychologists, and neurologists. This collaborative approach can help identify multiple factors contributing to speech difficulties, especially if there is suspicion of a neurological or cognitive disorder.

Interpreting Evaluation Results

After gathering the necessary data through observation, formal testing, and analysis, the SLP will provide an interpretation of the findings. The report will include:

1.     Diagnosis: Identifying the type of speech disorder (e.g., articulation disorder, voice disorder, etc.).

2.     Severity: Determining the degree of impairment (mild, moderate, severe, profound) and how it affects communication.

3.     Recommendations: Suggesting appropriate therapy options, interventions, or referrals. This may include a treatment plan for speech therapy, hearing aids, or counseling for parents or caregivers if needed.

4.     Prognosis: Offering an outlook for improvement, including how likely the individual is to benefit from therapy based on their specific speech disorder, age, and other factors.

Speech evaluation is an essential process for understanding the nature and extent of speech disorders. It helps identify areas of difficulty, determine their causes, and create a plan for intervention and treatment. Through careful assessment and tailored therapy, individuals with speech disorders can improve their communication skills and enhance their quality of life.

 

 

 

4.4   Evaluation of speech in terms of voice, articulation and Supra-segmental

 

 

The evaluation of speech in terms of voice, articulation, and suprasegmentals is crucial in understanding the complexities of speech disorders. These three components encompass the overall sound production and fluency of speech. A comprehensive assessment helps diagnose speech-related issues and plan effective treatment or therapy interventions. Here s an overview of how these three domains are evaluated:

 

1. Evaluation of Speech in Terms of Voice

Voice evaluation focuses on the sound produced by the vocal cords and the quality, pitch, loudness, and resonance of that sound. The goal is to assess whether the voice is functioning normally or if there are any disorders impacting speech production.

Aspects Evaluated in Voice:

• Pitch: The perceived highness or lowness of the voice. It s linked to the frequency of vocal cord vibration.
• Evaluation: Can be assessed through listening to the individual's conversational speech or through acoustic analysis using instruments like the Visi-Pitch.
• Disorders: Abnormal pitch levels (either too high or low) could indicate issues like puberphonia, vocal fold paralysis, or hyperfunction.
• Loudness: The volume or intensity of the voice.
• Evaluation: Can be measured through speech tasks and the aerodynamic measurement of airflow, as well as through perceptual assessments.
• Disorders: Hypophonia (too soft) or hyperloudness (too loud) could be indicative of conditions like neurological disorders or muscle tension dysphonia.
• Quality: Refers to the overall sound of the voice, including whether it is clear, breathy, hoarse, or strained.
• Evaluation: Perceptual assessments by listening to the voice quality and using tools like electroglottography and stroboscopy.
• Disorders: Hoarseness (raspy voice) can result from laryngitis, nodules, or polyps, while breathiness may point to vocal cord paralysis.
• Resonance: Refers to the balance between nasal and oral sounds during speech.
• Evaluation: This can be assessed through perceptual analysis and nasometry.
• Disorders: Conditions like hypernasality (excessive nasal sound) may indicate cleft palate or velopharyngeal dysfunction.

Voice Evaluation Tools:

Voice is the sound that the listener perceives when the adducted vocal folds are driven into vibration by the pulmonary air stream. The four most common approaches for clinically assessing the various aspects of voice production include:

1) auditory perceptual assessment of voice quality,

2) acoustic assessment of voiced sound production,

3) aerodynamic assessment of subglottal air pressures and glottal air flow rates during voicing, and

4) endoscopic imaging of vocal fold tissue vibration. 

Perceptual assessment

CAPE-V

Speech-language pathologists are increasingly being encouraged to use the new Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) for clinical assessment of voice quality. It provides a standardized framework and procedures for perceptual evaluation of abnormal voice quality that includes prescribed speech materials and visual analog scaling of a closed set of perceptual vocal attributes: overall severity of dysphonia, roughness, breathiness, straining, pitch and loudness.

Acoustics assessment

The validity and reliability of acoustic measures currently used in the clinic to objectively assess voice quality (e.g., jitter, shimmer, and noise-to-harmonics ratio) are inherently limited by a reliance on the accurate determination of fundamental frequency (F0), and these measures have been further restricted to the analysis of sustained vowels. F0 can be difficult or impossible to extract in disordered voices, and sustained vowels may not be representative of vocal function or voice quality during continuous speech.

Aerodynamic assessment

Phonation threshold air pressure

Since the early 1980s, clinical assessment of aerodynamic voice parameters has typically involved extracting estimates of average subglottal air pressures and glottal air flow rates from non-invasive measures of intraoral air pressures and oral air flow rates during the controlled (constant pitch and loudness) repetition of simple syllable strings. It was subsequently shown that important additional information about glottal phonatory status (including the presence of pathology) could be obtained from estimates of the minimum air pressures required to initiate the softest possible voice production the phonation threshold pressure. 

Endoscopic imaging

Ultra high-speed digital color imaging

There is an ongoing interest in exploring the use of high-speed imaging to supplement or replace stroboscopy in the endoscopic assessment of vocal fold vibration. This is because stroboscopy only provides a highly averaged view of the vibration pattern and is not capable of resolving detailed tissue motion within individual vibratory cycles. Digital video camera systems have recently become available with adequate light sensitivity and recording speeds to capture 4,000 to 10,000 high-resolution color images per second through a transoral endoscope, a substantial improvement over previous high-speed systems that produced lower quality grayscale images at slower capture rates. 

 

Assessing speech articulation involves evaluating a person's ability to produce individual speech sounds, as well as their ability to produce sounds in words and sentences. Here are some common methods used in speech therapy to assess articulation:

Speech Sound Inventory: The therapist will assess the person's ability to produce all of the speech sounds in the English language. This inventory may include sounds such as /p/, /b/, /m/, /t/, /d/, /n/, /k/, /g/, /f/, /v/, /s/, /z/, /sh/, /ch/, /j/, /r/, /l/, and /th/.

Oral Motor Examination: The therapist will evaluate the person's ability to move their mouth, tongue, and lips to produce speech sounds. This examination may include activities such as blowing bubbles, whistling, or puckering the lips.

Speech Sample Analysis: The therapist will listen to the person's speech to identify any errors or patterns of error. They may ask the person to repeat certain words or phrases to assess their ability to produce specific sounds.

Articulation tests are used to evaluate a person's ability to produce speech sounds accurately. These tests usually involve the person saying a list of words or sentences containing specific speech sounds. Some commonly used articulation tests include the Goldman-Fristoe Test of Articulation-Third Edition (GFTA-3) and the Clinical Assessment of Articulation and Phonology (CAAP).

Goldman-Fristoe Test of Articulation-Third Edition (GFTA-3) 

The GFTA-3 is an individually administered standardized assessment used to measure speech sound abilities in the area of articulation in children, adolescents, and young adults ages 2 years 0 months through 21 years 11 months. The Sounds-in-Words test can be completed in an average of 12 minutes, and the Sounds-in-Sentences test can be completed in approximately 4 minutes.

Clinical Assessment of Articulation and Phonology (CAAP).

The CAAP-2 is the most current assessment for articulation and phonology. It is time-efficient, accurate, and yields results that are easy to score and interpret. You may administer the Articulation Inventory in 15-20 minutes. The checklist approach to assessing phonological processes virtually eliminates the need for phonetic transcription. CAAP-2 is an assessment that you will like giving and children will enjoy taking.

CAAP-2 is a valid and reliable instrument. The CAAP-2 standardization sample included 1486 children from the U.S. and closely resembles 2013 U.S. Census Data. Concurrent validity studies comparing CAAP to the GFTA-2 and the KLPA-2 were significant beyond p<.01 for all raw scores, standard scores and percentile ranks (ranging from .789 to .948). Inter-rater reliability coefficients were all above .99.

COMPLETE CAAP-2 KIT INCLUDES: Examiner s Manual, Stimulus Easel, 50 Articulation Response Forms, 30 Phonological Process Record Forms, 5 foam CAAP Pals, and a big tote bag (2013).

 

2. Evaluation of Speech in Terms of Articulation

Articulation refers to the way speech sounds are produced by the movement of the lips, tongue, teeth, and other speech organs. This evaluation looks at whether a person can produce sounds clearly and correctly, and whether they have any errors that impact speech intelligibility.

Aspects Evaluated in Articulation:

• Sound Production: Assessment of how clearly the individual articulates specific consonants and vowels. This is typically done through a series of tasks such as repetition of words, sentence reading, and conversation.
• Evaluation: Standardized tests like the Goldman-Fristoe Test of Articulation or Photo Articulation Test can help identify sound substitutions, omissions, or distortions.
• Articulation Errors: Common errors include substitutions (e.g., saying "wabbit" for "rabbit"), omissions (e.g., omitting sounds like r in "red"), additions (e.g., adding extra sounds like "buh" in "bus"), and distortions (e.g., lisping on "s" sounds).
• Evaluation: A speech sample analysis allows the clinician to track the types and frequencies of errors.
• Phonological Processes: These are patterns of sound errors that children often make as they develop speech. These might include simplifying consonant clusters or fronting sounds.
• Evaluation: Assessment tools like the Khan-Lewis Phonological Analysis help identify whether a child s phonological processes are age-appropriate or indicative of a phonological disorder.

Articulation Evaluation Tools:

• Standardized tests (e.g., Goldman-Fristoe, Photo Articulation Test).
• Speech sample analysis: Spontaneous or structured speech tasks are analyzed to look for articulation errors.
• Oral-motor examination: Assessing the physical ability of the speech structures (lips, tongue, palate) to make sounds.

 

3. Evaluation of Speech in Terms of Suprasegmentals

Suprasegmentals refer to aspects of speech that go beyond individual sounds and words. These include intonation, stress, rhythm, and pauses, which affect the overall meaning, emotion, and fluidity of speech.

Aspects Evaluated in Suprasegmentals:

• Intonation: The rise and fall of pitch across a sentence or phrase. Intonation helps convey emotion, questions, or emphasis.
• Evaluation: Can be assessed by listening for monotony (lack of variation in pitch) or inappropriate pitch patterns in speech.
• Disorders: Monotone speech is often observed in individuals with neurological disorders (e.g., Parkinson s disease).
• Stress: Refers to the emphasis placed on certain syllables or words. Stress helps convey meaning (e.g., "record" as a noun vs. "record" as a verb).
• Evaluation: Observing whether syllables or words are stressed appropriately in conversation and structured tasks (e.g., reading sentences with different stress patterns).
• Disorders: Misplaced stress or reduced stress can be seen in apraxia of speech, dyspraxia, or some forms of aphasia.
• Rhythm and Rate: Rhythm refers to the timing and flow of speech, while the rate refers to how fast or slow speech occurs.
• Evaluation: Assessing the speech rate, including if it s unusually fast or slow, or if there s inconsistent timing.
• Disorders: An inconsistent rhythm or rapid rate of speech is often linked to stuttering or certain neurological disorders.
• Pauses: Pauses during speech can carry meaning (e.g., indicating a change in thought or emphasis).
• Evaluation: Listening for inappropriate or excessive pauses, which can interrupt the flow of speech.
• Disorders: Excessive pauses or inappropriate pauses could suggest issues with fluency or neurogenic communication disorders.

Suprasegmental Evaluation Tools:

• Perceptual assessment: The SLP listens for aspects like pitch variation, stress patterns, and rhythm.
• Acoustic analysis: Tools like Praat can analyze pitch, stress, and rhythm in speech.
• Speech sample: A structured speech sample can help assess the use of stress, intonation, rhythm, and pauses.

 

The evaluation of speech in terms of voice, articulation, and suprasegmentals is an essential part of diagnosing speech disorders and creating tailored therapy plans. Each of these domains plays a crucial role in the overall intelligibility and expressiveness of speech. Voice evaluation focuses on the health and functionality of the vocal cords and resonance, articulation analysis examines the production of speech sounds, and suprasegmental evaluation addresses the rhythm, pitch, and stress that affect the prosody of speech. Comprehensive assessment allows clinicians to identify specific areas that need intervention, leading to more effective treatment and improved communication for individuals with speech disorders.

 

 

 

4.5   Profiling in speech of the students in classrooms

 

Profiling in speech of students in classrooms refers to the assessment and documentation of individual speech characteristics and language abilities within the educational setting. This process helps identify students who may have speech, language, or communication disorders and ensures that appropriate interventions are provided to support their academic and social development.

Profiling involves observing and recording various aspects of a student s speech, language, voice, and communication patterns. By understanding each student's unique speech profile, educators and speech-language pathologists (SLPs) can tailor instruction, offer targeted interventions, and track progress over time.

A 'Student Profile' is defined as a collection of information about an individual or group of learners, including personal details, preferences, and academic information. It facilitates the sharing of student information among different platforms and helps in characterizing students within a learning system.

 

Steps in Profiling Speech of Students in the Classroom

1.     Observation

o   Teachers and speech-language pathologists (SLPs) observe students during everyday classroom activities (e.g., group discussions, oral presentations, peer interactions).

o   Observation should focus on areas such as articulation, fluency, social interaction, comprehension, and communication during academic tasks.

2.     Speech and Language Screening

o   A more formal speech and language screening may be done to identify any potential communication disorders.

o   Teachers may use informal checklists or standardized screening tools to assess communication behaviors like speech clarity, voice quality, or language understanding.

3.     Individualized Assessment

o   If a student s speech or language performance is concerning, a more detailed, individualized assessment may be performed by a speech-language pathologist.

o   This assessment can include tests of articulation, language skills (receptive and expressive), fluency, voice, and pragmatic language. Common standardized tools include the Goldman-Fristoe Test of Articulation, Clinical Evaluation of Language Fundamentals (CELF), and Test of Pragmatic Language.

4.     Documenting the Profile

o   A profile should be created based on observations and assessment results. This includes documenting strengths and weaknesses in areas such as articulation, fluency, voice, language development, and social communication.

o   A speech profile provides teachers with insights into how the student communicates, their challenges, and how they may benefit from support.

5.     Collaboration with Other Professionals

o   Teachers can collaborate with other professionals like SLPs, school psychologists, and special education staff to create a comprehensive picture of the student s communication abilities and needs.

o   This teamwork ensures that the student s academic progress is supported by a well-rounded understanding of their speech and language development.

6.     Setting Goals

o   Based on the speech profile, specific goals can be set for the student. These goals may target areas such as improving articulation clarity, increasing fluency, expanding vocabulary, enhancing social communication, or developing better voice quality.

o   Individualized Education Plans (IEPs) may be created for students with significant speech and language needs, outlining accommodations, modifications, and specific goals.

7.     Interventions and Monitoring Progress

o   After setting goals, appropriate interventions are provided. These may include:

  Speech therapy to address articulation or fluency disorders.

  Language support for students with vocabulary or grammar challenges.

  Social communication interventions for students with difficulties in social interactions.

o   Teachers should also monitor the student s progress over time and provide feedback to the student, their parents, and other professionals involved in their care.

 

Importance of Profiling Speech in Classrooms

1.     Early Identification of Speech and Language Disorders: Profiling allows for early identification of speech and language disorders that may affect academic performance and social interactions. Early intervention can prevent long-term communication difficulties.

2.     Tailored Instruction: Understanding the speech profile of each student enables teachers to provide differentiated instruction. For example, a student with articulation issues may benefit from visual or kinesthetic cues, while a student with fluency issues might need additional time to respond during oral tasks.

3.     Enhanced Classroom Participation: Students with strong communication skills are more likely to engage actively in classroom activities, participate in discussions, and form relationships with peers. Profiling helps identify students who may need support to participate more fully.

4.     Support for Social and Emotional Development: Students with speech and language difficulties may experience challenges with peer interactions, which can affect their emotional well-being. Profiling helps address these social communication issues, improving social integration and reducing feelings of isolation.

5.     Monitoring and Adjusting Support: Regular profiling and assessment allow educators to track students' progress and adjust interventions as necessary. It ensures that each student receives the support they need to succeed.

 

Profiling the speech of students in classrooms is an essential process for identifying communication difficulties early, providing targeted interventions, and supporting academic and social success. By assessing areas such as articulation, fluency, voice, language, and social communication, educators can better understand the unique needs of each student. This helps ensure that students with speech and language disorders receive the appropriate resources and accommodations to thrive in the classroom environment.