Speech Pathology is that branch of science that deals mainly with the structures and mechanisms involved in the production of speech. It deals with both the normal as well as abnormal aspects of speech production.
Speech Pathology/Therapy clinical services are provided to those who have concerns regarding various aspect of speech communication, speech mechanism and speech production. The overall objective of speech pathology/therapeutic services is to optimize individual’s ability to communicate effectively and with ease, thereby improving their quality of life by reducing or overcoming the impairments of speech mechanism. For availing the services, the patients may be self-referred or may be referred by any medical or allied professionals.
Speech Pathologists/Therapists are ‘Professionals’ in the scientific field of Speech Language Pathology, engaged in autonomous practice, to promote healthy verbal communication, communication competency, and quality of life for persons of all ages, through prevention, identification, assessment & (re)habilitation of speech, speech related functions, language and communication behavior. Speech Language Pathologists (SLPs) are the qualified and authorized group of professionals to treat people with Speech Language problems & difficulties.
At CAPAAR, the Clinical Services for Speech Disorders includes the following:
a. Clinical Services for Fluency Disorders
b. Clinical Services for Voice Disorders
c. Clinical Services for Articulation Disorders
The term fluency is derived from the latin word “fluere” which means “to flow”. In communication it means – “smooth & easy flow of utterances”. Therefore, fluent speech flows easily and smoothly in terms of both sound and information. It includes both ‘speech fluency’ as well ‘language fluency’. Fluent speaking is perhaps the most refined motor act performed by humans, requiring complex coordination of many different muscle groups.
When there are disruptions in the smooth & easy flow of speech, such that there prevails clear deviation in the continuity of spoken utterances, deviation in the smoothness, deviation in the ease with which the speech utterances are produced; then a “Fluency Disorder” is said to exist. The major disorders of fluency include – Developmental Stuttering, Neurogenic Stuttering, Psychogenic Stuttering, & Cluttering.
So, when the speech is frequently disrupted by “Repetitions”, “Blocks” & “Prolongations”, it takes the form of a fluency disorder terms as “Stuttering”. (Identified as Stammering in layman terms). Among the major forms of stuttering listed above, the most commonly seen clinical form is the “Developmental Stuttering”. In “Developmental Stuttering”, the speaker knows what to say, but is unable to say it without repetitions & prolongations. Although, this is normally seen in children between 2 years & 6 years of age, this can get carried over to teenage & adulthood, if proper intervention is not initiated at the right time.
Although there prevails different levels to developmental stuttering, the danger signs include the following:
Neurogenic Stuttering is a fluency disorder caused by neurological trauma or neurogenic diseases. It is also called as ‘Acquired Stuttering” or “Cortical Stuttering”.
Psychogenic Stuttering is again a fluency disorder that originates in the mind or mental activity of the brain such as thought & reasoning; and is characterized by a sudden onset.
Cluttering is another form of fluency disorder characterized by a speech that is difficult to understand due to rapid speaking rate.
Although there prevail different components to disfluent speech which are characteristic of each type, a careful examination & detailed assessment need to be done to diagnose and recommend treatment modalities.
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Voice in general refers to the modifications in the air stream (coming from lungs) taking place at the level of human voice box (called larynx) and above (up to the oral cavity). This means to imply that for ‘voice’ to materialize, air is very much required. Without air, there is no voice. Therefore, voice is produced by the vibration of vocal folds, resulted by the air pressure beneath it (from the lungs), and the subsequent modulation of the air stream in the entire tract above the vocal folds.
Normal Voice is minimally characterized by its “Loudness” –should be optimally loud enough to convey the vocal behavior, “Pleasantness(Quality)” –should have a pleasing voice quality, “Flexibility” –should be able to make contextual changes in voice when required, “Hygiene” –should be produced optimally wihtout resulting in any damage to the voice organs, & “Representation(Pitch)” –should have a true realistic representation of age, gender & personality. Whenever, these basic elementary characteristics are not followed, it results in the so called “Voice Disorders”. Thus Voice Disorders can be categorized into ‘Disorders of Phonation”, “Disorders of Resonance”, Disorders of Loudness” & “Disorders of Pitch”.
Phonatory Disorders are voice disorders resulted due to disturbances in the laryngeal system associated with the sound generators (vocal folds). These kind of disordered voices includes –Harsh Voice, Breathy Voice, Hoarse Voice, Aphonia, Dysphonia, Vocal Fry etc.
Resonatory Disorders are voice disorders resulted due to disturbances in the resonating structures of the vocal tract. These kind of disordered voice includes –Hypernasal voice, Hyponasal voice, Cul-de-sac resonant voice etc.
Loudness Disorders are voice disorders resulted due to disturbances in the aerodynamic events occurring in the laryngeal system. These kind of disordered voices includes –Aphonia, Spastic Dysphonia, Too loud voice, Too weak voice etc.
Pitch Disorders are voice disorders resulted due to disturbances in the tension & vibrating rate of vocal folds. These kind of disordered voices includes Puberphonia (male speaking in female voice), Androphonia (female speaking in male voice), Monopitch, Falsetto, Diplophonia etc.
Considering the wide range of disorders that prevails, a detailed ‘Voice Evaluation’ is very much essential to arrive at a correct diagnosis. As such voice evaluation is a systematic process of assessment of the entire vocal mechanism; which would include Respiratory mechanism, Phonatory mechanism, Resonatory mechanism & the Articulatory mechanism.
The articulatory system extends above the laryngeal level up to the two openings (oral cavity & nasal cavity) through which the acoustic energy can pass. The articulators are structures which include the jaws, lips, teeth, tongue, hard palate, soft palate etc. Movement of these structures shapes the vocal tract. And the shape of the tract determines the resonant properties of the voice.
Thus the articulatory structures can be used to aid the air flow as well obstruct the air flow so as to bring perfection to the production of voice pertaining to specific speech sounds. As such ‘Speech Articulation’ is typically described in terms of ‘articulatory contacts’ and ‘articulatory positions’.
This means to say that there is specific positions at which the articulators must come in contact and specific manner in which the air flow need to be directed so as to give a precise acoustic shape to various speech sounds. To facilitate this, a complex neuro-muscular coordination is very much essential. Whenever the speech motor coordination is lost, it results in the so called “Articulation Disorders”.
Disorders of Articulation includes ‘Phonological Disorders’; Articulation Disorders in Motor Speech Disorders like Dysarthria, Apraxia, Cerebral Palsy; Articulation Disorders in organic deficits like Cleft of lip & palate. It also includes articulation errors associated with hearing impairment, articulation errors associated with mental retardation, articulation errors associated with certain syndromes like ‘Down Syndrome’ and so on. And the range is very wide.
Normally, there are certain patterns of sound errors that typically developing children use to simplify speech as they learn to speak. These patterns are referred to as “Phonological Processes”. But when speech sound errors persists beyond what is developmentally appropriate to age, then there arises the disordered condition called “Phonological Disorder”. This includes a wide range of sound substitution, sound assimilations & syllable structure errors.
Articulatory errors are commonly seen in Dysarthria. Dysarthria is a family of motor speech disorders resulting from disturbed muscular control of speech mechanism due to damage of peripheral (Lower Motor Neuron) or central (Upper Motor Neuron) nervous system.
Articulatory errors are also seen in Apraxia of Speech. Apraxia of Speech is a motor speech disorder caused by brain damage, characterized by an impairment of motor speech programming, with little or no weakness, paralysis, or in-coordination of speech musculature.
Cleft of lip & palate also exhibit wide range of articulation errors. ‘Cleft’ is an elongated opening resulting due to the failure of the parts to fuse together in the early pre-natal development.
Articulatory problems are also common in clinical condition called ‘Cerebral Palsy’. Cerebral Palsy is a congenital non-progressive neuro-muscular disorder caused due to central nervous system dysfunction; wherein the lesion is located at a single or multiple locations of brain.
CAPAAR is an integrated therapeutical setup dedicated to treat kids with special needs. So that they can lead a meaningful and independent life.