Speech Sound Disorders Alert: Identifying and Fixing Nasal Fricatives in a Flash

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1 Speech Sound Disorders Alert: Identifying and Fixing Nasal Fricatives in a Flash Judith Trost-Cardamone, PhD CCC/SLP California State University at Northridge Ventura Cleft Lip & Palate Clinic and Lynn Marty Grames, MA CCC/SLP St. Louis Children s Hospital

2 Disclosures Judith Trost-Cardamone has the following disclosures relevant to the content of this seminar: Financial: Mosby-Elsevier, royalty; draws consultation fee for providing services to children with cleft palate and related speech disorders Non-financial: Coordinator, ASHA SIG 5: Speech Science and Orofacial Disorders; American Cleft Palate-Craniofacial Association, member, Journal reviewer; ASHA Professional Development Course: Cleft Palate Speech (2013) Lynn Marty Grames has the following disclosures relevant to the content of this seminar: Financial: Draws salary providing services to children with cleft palate and related speech disorders Non-financial: Past Coordinator, ASHA SIG 5: Speech Science and Orofacial Disorders; American Cleft Palate-Craniofacial Association, member, Journal reviewer

3 Rationale for this Session Nasal airflow errors are not restricted to individuals with physically impaired velopharyngeal (VP) closure; e.g., cleft palate Children with normally capable velopharyngeal (VP) closure mechanisms can present with learned nasal airflow errors These errors often present as nasal fricatives

4 Rationale for this Session In clinical management of speech sound disorders, we rely on perceptual speech findings to make our diagnosis, make appropriate referrals, and plan treatment Learned errors must be identified and distinguished from physically based cleft type speech errors because they require different management

5 Objectives Describe a useful nomenclature for nasal airflow errors (terminology & definitions) Identify the perceptual characteristics associated with learned nasal emission; e.g., the nasal fricative error Distinguish between learned (active) and obligatory (passive) nasal emission Identify phoneme specific pattern Know how to treat learned nasal airflow errors

6 What do you hear?

7 Definitions & Terminology

8 In any nasal airflow error, speech airflow is directed into and through the nasal cavity, and audibly released out the nostrils during production of a high pressure consonant: stop, fricative, affricate

9 Nasal Airflow Errors Two Types of Perceptual Realizations 1. Audible nasal air emission (ANE) that accompanies production of a high pressure consonant Target sound distortion 2. Nasal fricative (NF) that replaces the high pressure consonant Target sound substitution

10 Nasal Airflow Errors Can be Obligatory or Learned Obligatory (passive): due to VP insufficiency or fistula; true physical basis Requires physical management, secondary surgery Follow up post-op Learned (active): speaker directs air through the nose even when VP closure is physically possible; it is intentional Requires speech management Short-term therapy

11 Sources/Causes of Nasal Emission Learned or obligatory/ physically based? Taken and modified from Peterson-Falzone et al. (2006).

12 Obligatory vs Learned (PSNE) 5 yr old with unoperated submucous cleft palate 5 year old with learned (PSNE) pattern Note the turbulent nasal emission on all high pressure consonants and continuous hypernasality Note the good articulation of all pressure consonants except /s, z, ʃ ʧ ʤ/ which he produces as velar nasal fricatives in sentences (but with a /k/- like quality on repeated productions)

13 A Close-up Look and Listen

14 What is a nasal fricative? a nasal airflow articulation disorder misarticulation that combines exclusive nasal airflow with an oral articulatory placement It replaces the target consonant Can substitute for any pressure consonant, more typically, the sibilant fricatives and affricates /s, z, ʃ, ʧ,ʤ/

What does a nasal fricative look like? (articulatory placements & airflow; transcription) A B C Taken from Peterson-Falzone, Trost-Cardamone, Karnell & Hardin-Jones (2006).

15 What does a nasal fricative look like? (articulatory placements & airflow; transcription) A B C Taken from Peterson-Falzone, Trost-Cardamone, Karnell & Hardin-Jones (2006). voiceless fricative generated by airflow through nasal cavity (VP port is open) with simultaneous oral closure at (A) bilabial place, (B) alveolar place, or (C) velar place

16 What does a nasal fricative sound like? Taken from Peterson-Falzone, Trost-Cardamone, Karnell & Hardin-Jones (2006). Remember if the VP gap is small, there may be associated turbulence (i.e., snorting sound)

17 What do you hear?

18 Speech sample without /s/, /z/ targets Teddy had a dog Bobby had a puppy Be good today Daddy did it Go get cake today Chocolate chip cookie She brought chocolate Get the shoe Add nasal consonants: Five firemen put out the fire Get a bath in the tub Speech sample and audio provided by Mary O Gara, MS, Shriners Hospital for Children, Chicago, IL

19 Speech sample that elicits nasal fricatives for /s/, /z/ (minimal HN on contiguous vowels) Sue has a sister The zebra is at the zoo Two zippers The snake hisses I speak Spanish Second grade is fun Speech sample and audio provided by Mary O Gara, MS, Shriners Hospital for Children, Chicago, IL

20 Learned nasal fricatives typically present in a phoneme specific pattern, generically termed Phoneme Specific Nasal Emission (PSNE); also called Sound Specific Nasal Emission

21 Videonasendoscopy of 4 yr. old with PSNE/learned nasal fricatives

22 PSNE: How to Identify It? Nasal emission that is selective Typically affects sibilant fricatives + affricates /s, z/ + /ʃ, tʃ, dʒ/ Other pressure consonants are produced normally/orally this demonstrates physiologically adequate VP closure ability

23 PSNE: How to Identify It? cont. Can be realized in different forms, e.g., As a nasal fricative or turbulent nasal fricative substitution for the target evidence from expert observation suggests PSNE is realized most often as a nasal fricative As audible nasal emission or nasal turbulence coproduced with the target sound Negligible or no associated hypernasal resonance Vowels next to the affected target(s) may be mildly hypernasal Has a notable occurrence in youngsters with no cleft palate or other physically based VPI/VPD

24 Nasal Occlusion/Cul-de-sac Technique (gently plugging/pinching the nostrils closed) Works for diagnosis and therapy Diagnostic Info: Kids with learned nasal airflow disorder will continue to try to force air out the nose Kids with true VPI will accept the resistance and immediately allow the airflow to be redirected orally Therapy technique: Use nose plugging to redirect intentional nasal airflow and teach oral airflow

25 The Key Feature of PSNE The key feature of phoneme specific NE is the SELECTIVE aspect, the PATTERN of few sounds affected, and all OTHER PRESSURE CONSONANTS MADE ORALLY!

26 Fixing nasal fricatives in a flash! Therapy can begin at the initial dx session!

27 Techniques and strategies for treating phoneme specific nasal emission are the same, whether the misarticulation is realized as a nasal fricative substitution or as coproduced nasal emission

28 Resources Technical Assistance through ASHA - SIG 5 SLP on Cleft Lip & Palate/Craniofacial Team through American Cleft Palate-Craniofacial Association (ACPA)

Let s start by tuning our ears!

Craniofacial Speech Disorders: How to Identify, Transcribe & Plan Treatment Let s start by tuning our ears! Judith Trost-Cardamone, PhD - CCC/SLP, FASHA Professor, California State University-Northridge