This advice-column-style blog for SLPs was authored by Pam Marshalla from 2006 to 2015, the archives of which can be explored here. Use the extensive keywords list found in the right-hand column (on mobile: at the bottom of the page) to browse specific topics, or use the search feature to locate specific words or phrases throughout the entire blog.
Low Tone and Speech Therapy
By Pam Marshalla
Q: My client has low tone and many deviant phonological processes. Is this common? Does this mean he has dysarthria? How should my treatment look different from traditional articulation or phonological therapy?
Yes! If the child has hypotonia then this is dysarthria. Whenever you have muscle tone problems of a global nature, then dysarthria is the diagnosis. Dysarthria is a speech movement problem that is the result of muscle tone disturbance. (See definitions below)
It is common for children with low muscle tone to have speech movement problems, but the specific phonetic and phonological errors will be specific to the child.
In general all kids with severe speech disorders have the same basic problems to various degrees–– final consonant deletion, initial consonant deletion, cluster reduction, cluster deletion, prevocalic voicing, fronting and/or backing, stopping, stridency deletion, syllable deletion, etc. Dysarthric kids usually have vowel distortion, and both apraxic and dysarthric kids usually have an incomplete vowel set. Diphthongs often are shorted into single vowels and the schwa is over-used in both groups. Distortion of phonemes and the supersegmentals is the hallmark of dysarthria.
A client with a motor speech disorder needs to be viewed from all four speech movement subsystems–– Respiration, phonation, resonation, and articulation (jaw, lip, and tongue movement). His are not simple phoneme errors. His phoneme errors are the result of problems in the four movement subsystems.
In terms of therapy, the short and simple answer is that you work on phonemes and phonological processes just like you would for any other client, but you add work specifically to get the child to understand how his body works to inhale, exhale, prolong exhalation, turn his voice on and off, make sound oral and nasal, and move his jaw lips, and tongue in better patterns of mobility and stability. That is why therapists use blow toys, mirrors, tubes, and so forth. In the case of dysarthria, exaggeration is a key piece of treatment. Over-pronunciation is a key to clarity.
Classic Definitions of Dysarthria
“Dysarthria comprises a group of speech disorders resulting from disturbances in muscular control. Because there has been damage to the central or peripheral nervous system resulting in some degree of weakness, slowness, incoordination, or altered muscle tone.”
From: Darley, F. L., & Aronson, A. E., & Brown, J. R. (1975) Motor Speech Disorders
“A generic label for a group of motor speech disorders caused by weakness, paralysis, slowness, incoordination, or sensory loss in the muscle groups responsible for speech”
From: Brookshire, R. H. (1992). Introduction to Neurogenic Communication Disorders
I’m an SLP in Missouri. When my youngest daughter was 4days old she had a xyanotic episode caused by reflux and bad positioning. Long story short she did not show any developmental delays until about 7-8 months of age. She did not sit until 10 1/2 months, waled at 18 mo, and no verbal language until about 24 mo (despite all my efforts!). She is now 33 months and is talking quite a bit, still delayed but nonetheless talking! She has multiple phonological processes. But what us throwing me for a loop is…that she has changed from calling me /mimi/ to /mami/ to now /hami/. She also substitutes /h/ for /m/ in other words. I’ve never seen a child change their productions for words like that. Can you explain?
I don’t have all the info I would need to say this for sure, but my guess would be that your daughter is in the process of gaining stridency/affrication, and she is doing so with H. If she had no fricated sounds before this, and H is the first one she is gaining, then I would say for sure that she is pulling frication in and using it inappropriately, which she should for a little while. Research reveals that children gain MANNER before they gain PLACE. That is for typical kids. My own observations are that clients with severe motor speech disorders bring in MANNER before PLACE, and they also OVER-USE the manner before it settles on the right group of phonemes.
Even if she had a few other fricated sounds beforehand, I still would view it this way. Children with motor speech disorders do not seem to follow straight lines of phonological development. They blaze their own trail through the forest of phoneme and phonological acquisition.
Thank you so much Pam for the info! I had one motor speech course in grad school, but emphasis was on adults.
Ms. Marshalla,
We have an adult son (42) in the autism spectrum, who has always had an unusual tone of voice–sing-song, stilted, slow and precise in forming words. It has not caused any particular problems, other in taking his listeners somewhat by surprise, thus calling unwelcome attention to himself. At about age 10, a speech therappist gave this unusual speech pattern (pitch, tone, ?) a name–prosity, parosity, or something similar. Todd is now studying Spanish with a view to becoming engaged in a bi-lingual occupation. I am wondering if this unusual characteristic will make it harder for him to communicate in Spanish.
I am sorry, but I do not answer questions about autism. It is outside of my area of expertise.
Prosody is the word Todd’s speech therapist was referring to. It refers to the ‘rhythm’, ‘melody’, pauses and cadence of speech. Also no expert in ASD, (I am a licensed, certified SLP for 14 years), I would think that if Todd has prosody issues in English, he would likely have prosody issues in Spanish, but I give him kudos for studying a second language and wish him all the best to see where this will lead him!
Prosody is the traditional term, although many modern textbooks use the term “supersegmentals.” Anyway, just remember that some clients are very dysfluent in conversation but can sing beautifully and without error. Therefore, there can be differences in how prosody and articulation interact. I would not be surprised to find a client who has adequate prosody in one language but not another.
Hello,
What a wonderful website. My son is 20 months old and babbles constantly but has about 5-6 words. He understands everything but does have low muscle tone and is very flexible. Recently he started doing animal sounds– “mmmm” for moo and “-ck” for oink. Overall his words are just initial sounds. Is there anything I can do to get him to say entire words?
Thank you!
Hi! I have a daughter who will be 4 in December. She has very few words, less than 12. She does have low tone and gross and fine motor function took awhile to catch up to her peers. She is quite bright and knows many signs. We have been through two years of ST and run the gameet of diagnostic tests, all of which were normal other than tone. This is the first time I have heard of dysarthria and I am excited because it does sound like my child. Suggestion on what I can do at home with her to facilitate?
I am an adult age 40+ and have a normal lifestyle in most senses. I do however have a slight issue that seems to be growing concern for my family, friends and even myself. The tone and pitch of normal talking is way too high which makes people around me feel offensive. This unintended behavior throws people off and makes them feel unwelcome or avoiding conversations with me; in short it has consequences that i need to work on. This happens even during normal talking when I am not excited or angry. I do get upset fairly quickly and that raises the pitch and tone even higher. My elder brother has high pitch and tone as well, parents do not. Can speech therapist help lower the pitch and tone? What kind of anger management and/or therapy can be of help? I am in North Carolina. Thank you so much.