Fluency has to do with flow or smoothness of speech
Motor speech disorders – affect respiration, articulation, resonance, ataxia, apraxia (volitional movement of articulators and inability to sequence those movements)
Rest postures – when the mouth is at rest, how do the jaws line up; does the lower jaw hang open; where the tongue is placed.
Swallowing
[I didn’t catch the term for the] way the middle face grows, teeth erupt, the jaw grows
vocabulary, following instructions, complexity
Phonology – combining sounds into words
Resonance – movement of soft palate function
hypernasality – too much of nasal quality – results in high-pitch, almost whiny sound
hyponasality – too little nasal quality – can sound rather flat.
Oral-motor – structure and function of each muscle and speech system – lips, tongue, rest positions
After initial assessment: parent education; parent role in stimulating language development.
There are limitations to the services that can be offered. They may notice hoarseness, hypernasality, drooling, etc., these are not the area for a speech pathologist but might be referred to ENT.
Need to have some things corrected so that they can be able to build up pressure for consonants.
Dental anomalies may need to be corrected. (RHD note: dental anomalies are listed in the Beales paper on New Diagnostic Criteria. They include malocclusion [upper and lower teeth don’t sit right], crowding, micrognathia [lower jaw is too small].)
Swallow function – safety of oral feeding, rule out aspiration (food going into lungs), etc.
Hypernasality – may not be moving soft palate correctly.
Omitting final consonants – may not be using soft palate correctly.
Team approach – many related issues – may require speech pathologist,
Ear-Nose-Throat doctor, Maxillofacial surgeon, orthodontist, occupational therapist.
If an individual has motor coordination and planning problems, there is an area of expertise where therapists can go through courses to maximize low muscle tone, manage high muscle tone (Neurodevelopmental Treatment Approach) Web sites are provided in the handout for professional organizations.
There are specialty areas. You want to be sure the therapist with a specialty can also cover all the basics. If you get a good generalist, she should have resources for advice in special areas.
Controversial area: sucking and blowing – those really don’t address motor speech or airflow for speech.
Using sign-language to develop language and communication in absence of speech because of a motor problem to teach some basic sign language signs so that she could enjoy communication without having to wait until she was able to speak. Of course, BBS children often have poor fine-motor coordination and have difficulty imitating motor actions so getting her to learn signs proved to be hopeless.
Some kind of organized communication system – can be low tech (non computer) – is another way to help a child communicate. [RHD note: This is referring to things like making a poster of pictures of breakfast foods so your child can point to tell you what s/he wants for breakfast.]
Therapists need guidelines on BBS to know the breadth of what to explore. [RHD note: for starters, show them the table in Dr. Beales’ New Diagnostic Criteria paper. It lists issues re speech, language, and dental anomalies.]
