hearing loss & neuropathology
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articulation disorder
articulation disorder
articulation disorder
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hearing loss & neuropathology
Hearing loss causes variety of oral speech and verbal language problems. Various kinds of articulation problems are frequently seen in children and adults with moderate to severe hearing loss. Individuals who are born with deafness have the greatest difficulty in articulating speech sounds. Severe hearing loss makes it difficult not only to hear other people's speech but also to monitor one's own speech production. Even when the hearing loss is mild, the heard sounds may be distorted. Individuals with hearing impairment are likely to omit consonants in the final and initial positions. Omissions of /s/ and /z/ are common. These individuals also tend to substitute voiced for voiceless and nasal for oral consonants, and they distort many speech sounds, especially the fricatives. Although most children with speech sound disorders do not show gross neurological problems, neural damage of various kinds tends to cause those disorders, along with other communicative problems. These problems are found more frequently in adults than in children. However, communicative problems resulting from neural damage are different from functional speech sound disorders seen in most children. Various diseases and accidents can damage portions of the central nervous system concerned with speech production. When the parts of the brain or various nerves that controls speech muscles are damaged, speech production is affected. In such cases, the speech muscles are not able to execute the complex and rapid movements necessary to produce speech. Central or peripheral nerve damage causes a group of speech disorders called dysarthrias. Another speech disorder of neurological origin that includes speech sound errors is called apraxia of speech. Although there is damage to the central nervous system, there is no paralysis or weakness of the muscles of speech because the peripheral nerves that supply them are not damaged in persons who exhibit apraxia of speech. It is thought that speech programming in the brain is impaired in individuals with apraxia of speech. Some children who have difficulty producing speech sounds may have apraxia of speech and possible neurological involvement. This variety of speech sound disorder is called childhood apraxia of speech. Like adults with apraxia of speech, children with childhood apraxia of speech may show signs of trial-and-error grouping while trying to say certain words. The children can produce the movements necessary to make a speech sound but have difficulty making them in the context of speech production. Nonetheless, these children do not show evidence of gross neuropathology. Therefore, this diagnostic category is somewhat controversial, although it is generally believed that it exists.
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