REALES EN LOS PARQUES FUENTE DEL BERRO Y EL RETIRO (MADRID) Ext Día.

Augmentative and Alternative Communication (AAC)

A set of procedures and processes designed to improve (temporarily or permanently), the communication skills of individuals, with little or no functional means of

communication. AAC involves supplementing or replacing natural speech and / or writing with aided (eg picture communication symbols, line drawings, alphabet based methods) and / or unaided symbols (eg manual signs, gestures and finger spelling). Aided symbols are used with assistive devices including electronic devices (speech generating devices) and non-electronic aids (eg communication books).

The Carolina Curriculum for Infants and Toddlers with Special Needs 3rd Edition An assessment and intervention program designed for use with young children from birth to five years who have mild to severe disabilities. Developed for use with children from birth to 36 months, it is an easy-to-use, criterion-referenced system that clearly links assessment with intervention.

10.0 Definitions

© Waikato District Health Board 2014 ₁₃₈

The Carolina Curriculum Preschoolers with Special Needs 3rd Edition

An assessment and intervention program designed for use with young children from birth to five years who have mild to severe disabilities. Developed for use with children from 24 to 60 months, it is an easy-to-use, criterion-referenced system that clearly links assessment with intervention.

Receptive-Expressive Emergent Language Scale-3rd Edition (REEL 3)

A parent interview style standardised assessment designed to identify major receptive and expressive language problems in infants and toddlers.

Dysarthria

Dysarthria can be associated with any type of CP and can arise from any part of the vocal tract. Children with dysarthria associated with CP often have shallow, irregular breathing for speech (for instance speaking on small pockets of residual air; trying to produce a whole utterance rapidly on one short breath) and this may affect the rate at which they attempt to speak. They may also have what is perceived as a low-pitched, harsh-sounding voice, with little pitch variation. Hyper-nasal speech with audible escape of air through the nose and poor articulation may further reduce intelligibility. Disorders are more severe for children with dyskinetic CP than for those with spastic forms, but most of the perceptual characteristics (e.g. low pitch, poor breath control and imprecise articulation) are observed in children across the different types of CP. Pennington et al 2010.

As they get older, children with spastic diplegia or quadriplegia spend increasing amounts of time in fixed positions and may develop contractures and deformities which may lead to a regression in speech skills, particularly effecting loudness, resonance (increasing hypernasality) and voice quality. This regression can be particularly noticeable during times of rapid growth.

Spastic Cerebral Palsy

Children with spastic diplegia and mild-moderate spastic quadriplegia may develop speech skills early on. Articulation is normally quite good but they often have dysphonia secondary to a disorder of breathing.

• May have breathy voice quality, monotonous pitch, hypernasality, and voice quality changes throughout an utterance. (Seif,Netsell,&Kent,1981; Workinger &Kent,1991) • Variability and a decrease in loudness may result from an inability to maintain

constant subglottal air pressure across an utterance. These children may start a sentence with appropriate adduction/abduction of the vocal folds but then are unable to sustain adequate subglottal air pressure, and so the voice quality may become strained/strangled.

• Breathy and often quieter voice quality occurs when the vocal folds aren’t properly adducting (coming together to produce voicing)

• It is also possible that part of the reason why children with spastic CP use lower speech volume, is because it becomes a ‘learned behaviour related to the fact that there is often an overflow of muscle tone in the arms and legs when speech is produced loudly. By using a lower vocal intensity, the muscle tone in the extremeties can remain more normal’.(p32)

• Workinger and Kent (2000) described consistent hypernasality in speakers with spasticity’ (p33)

Ataxic CP

• May attain speech motor skills along normal developmental lines.

• Speech tends to be intelligible but there may be problems with speech rate, and timing. Articulatory distortions may also occur.

• Speech production tends to improve as the child gets older but the above types of speech difficulties mentioned may persist to some extent.

10.0 Definitions

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• Receptive language may be significantly better than verbal skills therefore these children may particularly benefit from early introduction of AAC.

• As they gain body weight, stability and more oral motor control, some children may develop functional verbal communication. This can occur as late as puberty to early adult years.

Athetoid CP

• In athetoid CP variations of loudness may be caused by fluctuations in valving the air stream at the level of the larynx (p32)

• Children with athetoid CP or mixed types of CP tend to show more abnormal oral movement patterns and postures.

• Workinger and Kent (1991) found that ‘children with athetosis showed more articulation errors than children with spasticity. The primary type of error for both groups was omission. Vowel errors and substitutions were next most frequent errors for the group with athetosis.’ Then ‘voicing errors and additions’.(p34) • Kent and Netseell (1978) and Hardy (1961) described ‘intermittent velopharyngeal

closure in individuals with athetosis caused by an instability of velar elevation and resulting in intermittent hypernasality. Very young children or individuals with severe athetosis may produce only nasalized vowels because of their inability to valve at the level of the velopharynx.’ (p33)