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Speech Visualization - Learning Fundamentals

1. LI If you are editing the client profile click OK to return to the main Client Manager window LocuTour Client Manager Clients Session History Guest Client 11 18 2010 01 20 57 PM 11 19 2010 01 39 36 PM 11 19 2010 03 01 11 PM New Profile Remove New View Graphs Y Remove Launch Game LI Launch the program by selecting Speech Visualization from Client Manager s Launch Game menu LI The first screen will help you set up your microphone The program will attempt to find the microphone that is attached to your computer but it will sometimes pick the internal microphone instead of an attached microphone To be sure that the correct microphone is 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 3 Select Microphone Speech Visualization found the following microphones attached to your computer Please select the one you would like to use Select Microphone Auto Select O 0 No details available O 1 No details available Speech Visualization is most accurate if you calibrate the microphone for your therapy environment Ambient room noise will affect the accuracy of the results Calibrate Saving Recordings _ Save all recordings automatically You can save the client s speech sample for each exercise by clicking on the Save Recording button If
2. Affective prosody includes the speaker s mood recognition of status between the listener and speaker i e adult to young child peer to peer and the person s typical speech style Whatever spoken by a frustrated teen has a different prosody than the same utterance spoken by a person lounging at the beach on a casual afternoon Rate Speech Rate is the number of words produced divided by the time taken to produce them It is reported as Words per Minute WPM Silence at the beginning and at the end of the sample is not included in the time Articulatory Rate is the number of words spoken per minute during segments of perceptually fluent speech The program cannot tell if the speech is fluent or correct so it uses number of words in the sample It calculates the time by measuring total time for the speech sample and subtracting the silence Silence is defined as no measurable amplitude for 250 ms within the sample Silence of any duration at the beginning and the end of the sample is not counted Vocal Quality is the description of the sound of your voice and what it communicates to others about you There are qualities that some individuals prefer to accentuate and others may wish to reduce Breathiness is one of these A common example is the starlet s breathy sexy voice as compared to an individual with Parkinson disease attempting to decrease the non vocalized air gaps Harshness describes a narrow ranged low pitche
3. A Characteristics observed were Normal Too Loud Too Quiet Too Much Fluctuation Inappropriate Absent Assessment Exercise 3 Loudness Measure in Context Speak into the microphone at a normal comfortable loudness level Complete three trials and select a sample for the computer to analyze Therapist Note The client will speak into the microphone at a normal comfortable loudness level The volume for speech will be measured and an estimate of how loudly they are speaking will be made Do not worry about pauses the computer will ignore silence Speech Visualization will display the length in seconds of the Quiet Normal and Loud production next to the Record button If the client is able to speak and at the same time observe the volume bar on the left side of the screen you can point out that Pink is too quiet Yellow is good for a quiet room Green is good for most conversations Orange is okay for outside voices Red is way too loud Speech Visualization will report the length of the sample the range in decibels and the average decibel level This average is calculated by using a time sample every 10 ms default but you can change it in the Tools menu When you are satisfied with the recording and have selected a sample click Next to continue 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 13 SOAP Note Rules Quiet whispered speech d Too qu
4. If you are unsatisfied with this sample you may have the client say uh huh as if to answer yes to a question Both syllables should be produced at the same pitch Follow the highlighting and selection process outlined above to determine the optimal pitch SOAP Note Rules O The client s optimal pitch ah was at Hz or on the musical scale The typical fundamental frequency f0 for a male female age ranges from Hz to Hz or from to The client was approximately Hz or ___ notes above below within this range Clinician Selected Check Boxes A Characteristics also observed were LI Too high Falsetto Too low Fry Too much fluctuation Misplaced pitch for single syllable words Misplaced pitch for multi syllable words Misplaced pitch for phrases or sentences LI Monopitch Reduced ability to rapidly change pitch LI Pitch Breaks are frequent Pitch Breaks are rare LI Inconsistent Volume Has difficulty conveying emotions through pitch Assessment Exercise 2 Finding Singing Pitch Range Setting the upper limit Take in a breath then yawn with an audible ah sound Raise your pitch one note for each number as you count up the scale to eight ah two three four five six seven eight Typical range is 12 notes you may add more 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 17 Therapist Note The Pitch Range exercise allows you to determine your client s
5. Locufour Multimedia Speech Visualization by Marna Scarry Larkin MA CCC SLP e098 LocuTour Speech Visualization Guided Session Voicing Dx 1 Evaluation of Glottal Stops and Breathiness Take in a breath yawn then exhale with an audible sigh or ah sound to establish optimal pitch Now say If only ate eggplant instead Model Zoom 4150 Hz _ 85 dB__ 2350 Hz 80 dB _ 1330 Hz 760 Kz Load Recording r Practice Glottal 9 5 Breathy 8 824 Sample Time 3 2s 40 Hz C recors JC pray 4 tet to 4 View your clients speech waveforms in real time and analyze voice qualities Keep detailed records with LocuTour s Client Manager Table of Contents Speech Visualization anere ea e suas E E E ese ede A A a a 2 VVC oeni nnee ea a a tr a ae iced a ae eee a a e a ash a aa e aad 2 DINTA KSI 0 1 ane mn ee EA Re E E E A E E 3 Interpreting the Speech Sample s snsnssesessseeeseeseesseesesrssseessesseessessrssrtessesrsstessrsstesseeseesseesseseest 5 Colors for the Sound Level Meter nw atend eisai can aneeielie wasnt yies 5 Colors fot Pitehand Volumen iensen aia geen noice 6 Colors for Glottal Stops and Breathiness c ccccccccsscesescceeeteceseceeeeesseeeeeteeenaees 6 Colors for Timing Rate and Rhythm sseseessseeseeesseesseessesssessesssessressessseese
6. Vowel Productions on Vowels before m n and ng Consistently accurate rarely heard nasality lt 10 Mostly accurate but some assimilation nasality heard in 11 15 Frequently accurate but noticeable nasality 16 25 Infrequently accurate nasality affects communication 26 80 Inaccurate nasal resonance nasal emission observed gt 81 Nasal Production on Nasal Sounds m n and ng Consistently accurate correct nasality 90 100 Mostly accurate but some denasalization on m n ng heard in 85 89 Frequently accurate but noticeable nasality 75 84 Infrequently accurate denasality affects communication 20 74 Absent Inaccurate hyponasal vocal quality or lack of nasal resonance 1 observed gt 19 Clinician Selected Check Boxes A Same as Syllable Stress and Sequencing Assessment Exercise 1 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 70 Check boxes that are available for each session The following checkboxes are available to assist in creating SOAP notes They are found on the Session Summary page Subjective Observations S During this session the client was observed to be Alert Confused Oriented Disoriented LI Attentive Distracted Cooperative Uncooperative Putting forth good effort Putting forth minimal effort On time to appointment Late to appointment Objective O The raw scores and percentage scores from the the computer
7. Vowel sounds with r aer eer ier oer uer yer ir Or ar 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 57 Module 7 Vocal Quality and Resonance Assessment Exercise 1 Nasal Resonance Nasal Emissions Test words Say the following words in two ways The pinched speech production is accomplished by lightly pinching the nose to determine if there is nasal resonance Click on the Zst Syl checkbox if nasal emission was heard on the first syllable and select the 2nd Syl checkbox to indicate nasal emission on the second syllable There should not be a difference between the pinched and unpinched productions If there is there may be velopharyngeal incompetence Therapist Note These exercises will allow you to evaluate the vocal qualities and resonance of the speaker There are both subjective and objective values to consider when determining what is normal or deviant in vocal quality The physical structure culture and projections of emotion attitude and mood can all subtly and overtly change the vocal quality This is a tool to use to allow you and your client to make those judgments The tasks suggested are typical activities found in Voice textbooks The results page will give a percentage of scored productions for the first and second syllables The computer does not score these the clinician makes the judgment of Correct or Incorrect There should not be a difference bet
8. M M amp Lokken K J 1989 Speaking rates of young children Language Speech and Hearing Services in Schools 20 133 138 Ramig L O amp Verdolini K 1998 Treatment efficacy Voice disorders Journal of Speech Language and Hearing Research 41 101 116 Robertson S J 1987 Dysarthria profile Tucson Communication Skill Builders Ryan B amp Van Kirk Ryan B 1995 Programmed stuttering treatment for children Comparison of two establishment programs through transfer maintenance and follow up Journal of Speech and Hearing Research 38 1 Shriberg L D Paul R McSweeney J L Klin A amp Cohen D J 2001 Speech and prosody characteristics of adolescents and adults with high functioning autism and asperger syndrome Journal of Speech Language and Hearing Research 44 1097 1115 Slaney M amp McRoberts G 1998 Baby ears a recognition system for affective vocalizations Proceeding of the 1998 International Conference on Acoustics Speech and Signal Processing Retrieved from http www interval com papers 1997 063 Smith A B Roberts J Smith S L Locke J L amp Bennett J 2006 Reduced speaking rate as an early predictor of reading disability American Journal of Speech Language Pathology 15 289 297 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 79 Singh S amp Frank D A 1972 Distinctive feature analysis o
9. retains fluid in the tissues Those lozenges with eucalyptus or mint are not helpful they seem to have a drying effect 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 81 Uses of the Vocal Exercises Heal the throat If your ENT says you have a tissue growth that can be gotten rid of vocal exercises will help Prevent recurrence of the nodule If you go through therapy do well continue to use the techniques it is unlikely that the nodules will return Warm up the voice tv Recuperate the voice Once in a while you may have problems even if using the voice correctly Rest the voice and do the exercises before bed Goals of Voice Therapy I Physiologic 1 Activate breathing 2 Proper laryngeal tonus increase or relax 3 Distribute resonance 4 Eliminate all medical problems Evaluation by an otolaryngologist is important to determine if there is pathology including vocal nodules polyps contact ulcers or paralysis of one fold Eliminate colds allergies environmental contributors 5 Stop vocal abuse 6 Reduce edema II General 1 Best pitch possible 2 Best loudness possible 3 Best quality possible 4 Most flexible consider all three areas 5 Create normal healthy tissue replace granuloma etc 6 Normalize throat feelings 7 Provide a voice that satisfies the patient s needs especially the work voice 2007 2010 LocuTour Multime
10. 4194 10 sjeob Kouan W13 Buo y S 0 8 qe y BSN ues s yoe uoppe uj wWesHosd Buipying Aouan y e p u sje zew jacaj apei6 wo shuipesas pasoesdun om jo a109s aBesane y Buisn aj1jua049d yz0S 34 MOjEq SP1OM sow JO OL Bulioos sjuapnjs s uapnjs uno jo Aouany Huipesai jeso ay jnoge suolsi9ap yewu pue SUOISN OUOD Mep 0 9 qe Siy u UONEWJOJU BY Asn ued noA elep sjepuly pue yonosqsey Aq pauiwuajap se g yno sapes6 ul s u pn s yo Aouany Bulpess jeso ueaw y smoys moj q 9 qe y L rr9 9e9 Z 6g seyoee Bulpesy ey syayoes Bulpeai 104 J00 zuawss sse jqenjea y swsou AoUuany Bulpeal eo 900Z Y IeEpuIL 8 r YONOUGseH 9007 Ul Jeyoeay Bulpeay y u pue 06 wjyy spiodas yoaynpauobaion pq ayisqam s uobalC jo yss anunN y UO JU WAA0IdU sNdIM WdOM ANd OM ajjueoied ajqeyiene si YDYM JuaWainseayy Jo SIEA 06 AoUaN 4 BuIpeay 210 panue Ayyaem Bay Bunds 19 U1M Wes i pod jeo1uyo9 e ul p ys jqnd z m Apnjs y zo s jnses y Aouany Buipeal Jeso Jo Apnys nsu a x ue p jdwo aney jepu pje129 pue yonosqsey uer eyeq Aouan 4 Buipe y JLI epu 8 YINOIqSeH 900Z 800 777 3166 or www LocuTour com 2007 2010 LocuTour Multimedia Inc All Rights Reserved Page 38 Guide Conversational Rate children from Pindzola et al and Smith et al Ages 3 5 from Sturm and Seery Ages 7 11 Age Speaking Rate Speaking R
11. 9 V 7 Maybe you might like to come running and jumping and merry C 8 V 5 making with me on Monkey Song Lane she said C 8 V 5 Never muttered the Mastiff I don t want a mutt around me C 7 V 5 So while the Mastiff sat making angry noises and being mad C 12 V 10 Matilda Jane was singing and dancing down Monkey Song Lane C 7 V 6 and never had a nice mutt had a nicer time being a mutt Kalamazoo C 5 V 4 An old man from Kalamazoo C 8 V 3 Once dreamed he was eating his shoe C 1 V 0 He awoke late that night C 1 V 1 In a terrible fright C 4 V 3 Now instead of one tongue he has two Quotes C 3 V 2 never did a day s work in my life C 1 V 1 It was all fun C 2 V 2 Thomas Edison C 3 V 4 Every morning get up and look through the Forbes C 2 V 2 list of the richest people in America C 2 V 1 If I m not there go to work C 1 V 1 Robert Orben C 4 V 3 Mama exhorted her children at every opportunity to C 7 V 6 jump at the sun We might not land on the sun C 1 V 1 but at least we would get off the ground C 2 V 2 Zora Neale Hurston 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 68 Definitions C 1 V 0 Rattlesnake A tattle tail C 2 V 2 Caterpillar An upholstered worm C 1 V 1 Zebra A horse behind bars C 2 V 2 Big Ben The tock of the town C 2 V 2 Acrobats People who turn a flop into a success C 2 V
12. C 5 V 4 Oh do you know the muffin man C 2 V 2 Who lives on Drury Lane C 5 V 4 Oh yes know the muffin man C 8 V 6 The muffin man the muffin man C 5 V 4 Oh yes know the muffin man C 2 V 2 Who lives on Drury Lane Ten Little Monkeys C 6 V 5 Ten little monkeys jumping on the bed C 8 V 3 One fell off and bumped his head C 8 V 2 Mama called the doctor and the doctor said C 7 V 6 No more monkeys jumping on the bed 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 67 Matilda Jane Meets The New Neighbor C Q V 6 Once upon a time there was a nice mutt named Matilda Jane C 8 V 7 She lived on Monkey Song Lane in Montana C 9 V 7 She spent most of her mornings running jumping C 9 V 7 and merry making on Monkey Song Lane C 7 V 6 Never had a nice mutt had a nicer time being a mutt C 12 V 8 One morning a moving van neared Monkey Song Lane C 11 V 9 Many many noises were emanating from the moving van C 6 V 4 nasty sounds made by one angry mutt C 7 V 5 Matilda Jane being interested navigated behind the van C 6 V 4 as it moved down Monkey Song Lane C 7 V 5 When the moving van stopped Matilda Jane made her C 6 V 6 way to the front of the van following the angry nasty sounds C 5 V 4 She saw a monstrous Mastiff growling and drooling C 8 V 3 from the front of the van C 6 V 3 Matilda Jane smiled I m Matilda Jane C
13. Fall Spring Fall Spring 15 oo ee ees ar Ea js i wo Bo 5o 8 o a ee e S o as aS o 5 ea g oo o e a 88983 7 o 204 98 15080202 E A 7c SE a E Guide Conversational Rate adults Words per Minute WPM Type of Speech 140 180 Typical but some speakers will still be considered acceptable at faster rates 150 185 Fast typical 160 170 Considered superior if the speech is clear and intelligible The content must also be such that it can be understood at that rate 180 410 Exceptionally fast but may be appropriate if the material is energetic or even forceful or angry 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 37 woo fjjesnyeupeas MMM ymo yaem Jed spiom aBesany PNUIN d 3991109 SPION WdOM Lg 06 JUBWOAOIGUY NOM Wd9M aijuesseq Aiyoom Bay lled i sju wuss sse Buuds pue 13 uIMm y u am q Sy9emM Jo saqwunu edIdA y 9 Aq u 1 p 94 BulpiAip pue ai0os Huds y Wo 9100S J9 UIM y Huyoegqns Aq pajejnojeo sem jUBWAdAOJdWI AjyOOM BBeJOAe y zu wss sse e OU s au souls apei6h 104 szu wss sse Hulids pue e y UdaMjeq SYI M Jo Jaquunu jeaid y ze q aousJayip ay HulpiAlp pue soos Buuds y WO 3409S ie y Bupoenqns Aq payejnojeo sem j JUapNy s e woz 2 dx ueo noA yymoi6 y m s d sp om abesaAe y s JuaWAaAOIdU jy m Hes ny syapeas Bulj6Gnys
14. LocuTour com Page 41 Assessment Exercise 2 Deep Test IMF These words contain a target sound in the initial medial or final position Say these words paying close attention to the target sound Score each production before moving to the next screen p paw hippo up b bow oboe eab day hiding fhead e eme wagon ese does not occur in English in this position Therapist Note This articulation deep test is designed to evaluate the client s speech for accurate production of 24 consonant sounds in the initial medial and final positions Some sounds are not produced in some positions in English these have been omitted The client will be presented with one word in each of the three Text boxes They may read the model or listen to the speech model imitative Click on the Record button in each Practice box and have the client say the word Record over the sample until you are satisfied with the production Speech Visualization will save the production so that you can re play it later to demonstrate progress When the client has finished recording the clinician will need to score each production as C Correct or 1 Incorrect The words are listed with the target sound in the Initial Medial or Final positions These will be reported as correct or incorrect by position and sound on the results page Vowels should not scored in this exercise You may use the Assessment Notes to indicate sound substitutions 2007 2010 L
15. Other Observations Occlusion A The Occlusion appeared to be Normal molars touch have an Underbite have an Overbite have a Crossbite Other Observations Dentures A The client wears dentures LI they fit well LI they don t fit well and client consistently wears them and client doesn t consistently wear them Other Observations Oral Hygiene A The client s Oral Hygiene is Normal and independent Requires assistance is Poor and may contribute to poor health LI Other Observations Mucosa A The client s Mucosa is Healthy gingiva scalloped firm knife like margins stippled texture is Diseased gingiva inflammation rolled margins no stippling gingiva is erythematous edematous and or painful Other Observations 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 90 Saliva A The client s Saliva is Healthy watery clear is Diseased thick discolored yellow green black red is Absent xerostomia dry mouth painful mouth Other Observations Oral Peripheral Evaluation Jaw Mandibular Movement A The evaluation of Mandibular Movement for Range of Motion LI was Normal LI was Reduced Symmetry of Jaw LI was Normal Deviates to the right LI Deviates to the left Movement of Jaw was LI Normal LI Jerky Groping Slow Asymmetrical Tempromandibular Joint A Tempromandibular Joint TMJ Noises LI were Abs
16. Patient with oral phase dysphagia LI Patient with GERD hiatal hernia reflux rumination erosive esophagitis or gastritis LI Patient with a history of aspiration pneumonia Level 4 All other patients This level has no diagnosis of dysphagia GERD or choking risk Proposed Diet Levels National Dysphagia Diet A Follow up evaluation or screening for a possible swallowing disorder is indicated The following dysphagia risks were reported or observed in the course of treatment NPO Nothing by mouth LI Intravenous LI Nasogastric N G tube Gastrostomy PEG tube NDD Level 1 Dysphagia Pureed homogeneous very cohesive pudding like requiring very little chewing ability NDD Level 2 Dysphagia Mechanical Altered cohesive moist semisolid foods requiring some chewing LI NDD Level 3 Dysphagia Advanced soft foods that require more chewing ability NDD Level 4 Regular all foods allowed Orientation Check all that apply A The patient was observed to be Non responsive LI Disoriented confused L Agitated L Emotional labile Oriented Alert Cooperative 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 97 Differential Diagnosis Dysarthria Dysarthria A The following behaviors were reported or observed in the course of evaluation and or treatment Follow up evaluation by a physician for a possible neurogenic disorder is indicated Information compiled from Da
17. a picture of the amplitude and pitch over the entire sample The Phonetogram has no time component If you want to save the Phonetogram to review later click the Save Graph button at the bottom of the window The Phonetogram is a snapshot of both the pitch and the volume for a speech sample The blue columns represent the volume The longer the blue column the more time was spent at that volume level These were measured in decibels dB and plotted on the Y axis In most speech samples you will see that most of the speech sample was spoken in a specific range although there may be short instances where the speech was too quiet and too loud below 65dB and above 86dB Speech at the bottom of the chart are very quiet sounds speech at the top of the chart are very loud sounds The X axis shows the pitch range in Hertz it is not labeled Lines on the left of the chart are lower pitched sounds and lines on the right are higher pitched sounds You must complete Dx2 Finding Pitch Range before you can do Dx3 Pitch Range in Context SOAP Note Rules O The client s pitch range in running speech is from ____ to ___ Hz or to on the musical scale The typical pitch range for a male female of age is to___ Hz or to on the musical scale The client has a broader than narrower than average pitch range The client has a pitch range of notes The client had __ notes within the normal range __ notes were above the normal range and __ were
18. act as a prism and form a rainbow The rainbow is a division of white light into many beautiful colors These take the shape of a long round arch with its path high above and its two ends apparently beyond the horizon There is according to legend a boiling pot of gold at one end People look but no one ever finds it When a man looks for something beyond his reach his friends say he is looking for the pot of gold at the end of the rainbow Throughout the centuries people have explained the rainbow in various ways Some have accepted it as a miracle without physical explanation To the Hebrews it was a token that there would be no more universal floods The Greeks used to imagine that it was a sign from the gods to foretell war or heavy rain The Norsemen considered the rainbow as a bridge over which the gods passed from earth to their home in the sky Others have tried to explain the phenomenon physically Aristotle thought that the rainbow was caused by reflection of the sun s rays by the rain Since then physicists have found that it is not reflection but refraction by the raindrops which causes the rainbows Many complicated ideas about the rainbow have been formed The difference in the rainbow depends considerably upon the size of the drops and the width of the colored band increases as the size of the drops increases The actual primary rainbow observed is said to be the effect of super imposition of a number of bows If the red of the second bo
19. breathing gt Talk softer than you think is necessary gt Use exaggerated diction Let the crispness of the sounds cut through the noise gt Make maximum use of amplification gt Get feedback A person is most likely to abuse the voice if there is no monitoring of volume Physical Hygiene gt Drink water Cool room temperature is best Avoid extremes of temperature Purpose is to hydrate the tissues local and systemic benefits gt Take a steam bath or use a humidifier gt No coffee no tea Non herbal teas have tannins which dry the throat Fruit and herbal teas are okay as long as regular tea is not added gt Avoid medications that dry out the mouth and throat They take away lubrication Xerostomia is the name for dry mouth Some commercial products like Biotene mouthwash and lubricating spray can be helpful gt Avoid aspirin if possible It s a vasodilator that affects the thin walls and membranes gt Valium use judiciously Check other medications that may cause dryness gt Alcohol has a drying effect and is also a vasodilator One may also lose cortical control over speech gt Avoid spicy foods Very hot foods can irritate the folds If there is a problem with regurgitation at night don t eat too soon before bed sleep with the head inclined Get an evaluation for possible Gastroesophageal Reflux Disease GERD gt Lozenges anything with glycerin is okay Glycerin has a coating action that
20. for that the passing there Had worn them really about the same And both that morning equally lay In leaves no step had trodden black Oh I kept the first for another day Yet knowing how way leads on to way I doubted if I should ever come back I shall be telling this with a sigh Somewhere ages and ages hence Two roads diverged in a wood and I I took the one less traveled by And that has made all the difference Total Words in Passage 144 I have a cat Her name is Kitty She is nice She likes to sit on my lap I feed her cat food When she is happy she purrs I like to hear her purr She is my friend Total Words in Passage 39 Therapist Note My Kitty Speech Visualization will measure the client s reading rate by recording a passage and measuring the amount of time it took them to read it First check to make sure the client can read the text in the Passage box If necessary click the Larger font checkbox to make the text larger When you are sure the client can read the text click Record and have them begin reading When they are finished reading click Stop Speech Visualization will determine the length of time it took for the client to read the passage and calculate their speed in Words Per Minute WPM 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 33 Speech Visualization will ignore silence at the beginning and end of the recordin
21. in conversation is significantly poorer than in isolation LI Speech was consistently accurate LI Speech was intelligible with careful listening Speech was mostly accurate but errors were observed LI Speech was frequently accurate but noticeably in error LI Speech was infrequently accurate but occasional accuracy was possible LI Speech contained multiple sound omissions deletions and or substitutions L Speech characterized by vowelization LI Gestures supplemented speech LI Tongue protrusion LI Mouth open at rest Speech improved with external prompting ne of Errors Initial consonant errors Medial consonant errors Final consonant errors LI Vowel production errors Evaluation of consonant clusters is indicated 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 47 Treatment Exercise 1 Articulation Use information from the Assessment Exercises to select the appropriate treatment exercises from LocuTour s Articulation programs Artic Games and More includes all consonants vowels and clusters The following games have specialized targets Articulation I Consonant Phonemes Articulation IT Consonant Clusters Articulation II Vowels R and R Clusters Artic Games Just R Artic Games Just S Artic Games Just L Guide Speech sounds most often misarticulated target Hearing Children English speaking most to least often w foka a foe o y Information extrapola
22. it to her He was the one in the black hat 34 her Her coat was over there on the chair It was her problem to begin with 35 him What did you think of him Why did they give the part to him 36 his It was great to see that his job was done His job was to remember to turn off the lights 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 26 37 some Pd like some please Some think my sense of humor is sharp 38 that I don t suppose that is on sale is it That was a spectacular temper tantrum 39 them We gave them the extra dessert She walked past us and gave the award to them 40 us The waiter brought us the water We had been practicing so it was easy for us 41 you I guess you will know soon You of all people should know 42 yours The blue one in the corner is yours After this payment the truck will be yours Therapy Exercise 5 Pitch Range Practice Speech in Context Speak or read for at least 10 seconds to determine your pitch range in running speech Make modifications to your pitch range based upon the visual feedback from the phonetogram Therapist Note Same as Pitch and Intonation Assessment Exercise 3 SOAP Note Rules O Same as Pitch and Intonation Assessment Exercise 3 Clinician Selected Check Boxes A Same as Pitch and Intonation Assessment Exercise 1 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 31
23. of non speech sounds LI Audible inhalation or snorts LI Acceptable yet noticeable level of nasality for culture or regional dialect Alternate Nasal Emissions Test single sound P Say P sounds like the letter name p 10 times The pinched speech production is accomplished by lightly pinching the nose to determine if there is nasal resonance Click on the J incorrect counter for each nasal emission then click on the C correct counter to indicate no nasal emission There should not be a difference between the pinched and unpinched productions If there is there may be velopharyngeal incompetence Therapist Note This exercise is for clients who are young or who can t say words Say P sounds like the letter name p 10 times The pinched speech production is accomplished by lightly pinching the nose to determine if there is nasal resonance Score 10 productions Click on the 7 incorrect checkbox for each nasal emission then click on the C correct checkbox to indicate no nasal emission The results page will give a percentage of scored productions The computer does not score these the clinician makes the judgment of Correct or Incorrect There should not be a difference between the pinched and unpinched productions If there is there may be velopharyngeal incompetence These exercises will allow you to evaluate the vocal qualities and resonance of the speaker There are both subjec
24. rived donee diana once evan bates 84 History Hearing AGUIYI 87 Structure Oral Peripheral Ev aluatrOii s ycic lt scesectsetocesescacea sss ssuces ve teens decedent sauces sd cegunees sade nseustoduies seen 88 Risk Assessment iE R DOr VSD iseinean ania a e a aan aiaa 94 Risk Assessment Dy splat s53ctsiedscctsqacesstedeesdsagcadessdactecas civ sbeater sdk a R a aie ea A a a 95 Differential Diagnosis WySariiild ced caeecuco vase tecedecassiedeanshsnstapauaoasegectenraicaniounnessmesteccusaneesddaeeecoal dewades 97 Follow p Further evaluati t ocreata ti ys belek vaatault das csp eo wees aaRS as 100 Troubleshooting m eonen a issue a eo Sanaa ade ane ho Ant use aaa 101 Scarry Larkin M 2010 Speech Visualization San Luis Obispo CA LocuTour Multimedia 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 1 Speech Visualization Speech Visualization by LocuTour Multimedia is an easy to use spectral speech tool that allows real time viewing of speech visual comparison between speech models analysis of the voice sample using common terminology and simplified record keeping The program can assist the speech professional in evaluating speech production but it does not diagnose treat or substitute for medical consultation or evaluation The program provides prompted speech models for you to use in evaluating and monitoring your client s speech The program also provides tools to guide you
25. sounds m n ng and enter into Nasal on Vowel Count the number of correct nasal productions made when saying the consonant sounds m n ng and enter into Nasal on Consonant The Muffin Man Oh do you know the muffin man The muffin man the muffin man Oh do you know the muffin man Who lives on Drury Lane Oh yes I know the muffin man The muffin man the muffin man Oh yes I know the muffin man Who lives on Drury Lane Ten Little Monkeys Ten little monkeys jumping on the bed One fell off and bumped his head Mama called the doctor and the doctor said No more monkeys jumping on the bed Continue if desired with 9 8 7 etc to 1 Matilda Jane Meets The New Neighbor Once upon a time there was a nice mutt named Matilda Jane She lived on Monkey Song Lane in Montana She spent most of her mornings running jumping and merry making on Monkey Song Lane Never had a nice mutt had a nicer time being a mutt One morning a moving van neared Monkey Song Lane Many many noises were emanating from the moving van nasty sounds made by one angry mutt Matilda Jane being interested navigated behind the van as it moved down Monkey Song Lane 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 65 When the moving van stopped Matilda Jane made her way to the front of the van following the angry nasty sounds She saw a monstrous Mastiff growling and drool
26. the force timing rhythm speed and overall coordination of all bodily movements Drunk like motor patterns Gait disorders wide and reeling gait Slurred articulation Intermittently explosive voice pitch and loudness outbursts Intention tremors during purposeful movements Tremors disappear at rest Swallowing is usually normal 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 98 HAypokinetic dysarthria A The client exhibited the following symptoms consistent with Hypokinetic Dysarthria LI Damage to the upper brain stem extrapyramidal system Imprecise articulation of sounds Harsh hoarse voice quality Abnormal bursts of speech that sound like the individual is tripping over his or her tongue Widespread rigidity i e stiffness and limited range of motion hypokinesia Tremors Incoordination of the tongue lip jaw and laryngeal muscles Trunk and limb disturbances _ Rest tremors of the hands LI Stooped posture Shuffling gait Mask like facial expressions Swallowing difficulties HAyperkinetic dysarthria A The client exhibited the following symptoms consistent with Hyperkinetic Dysarthria LI Damage to nerve pathways and centers within the depths of the brain subcortex known as the basal ganglia extrapyramidal system Difficulty maintaining posture muscle tone bodily adjustments and overall stability during gross voluntary movement patterns Rigidity Increased muscle
27. the graph Review these then click Next when you are ready to continue SOAP Note Rules O Same as Voicing Assessment Exercise 1 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 29 Clinician Selected Check Boxes A Same as Voicing Assessment Exercise 1 Therapy Exercise 2 Voicing Practice Sounds Phrases and Sentences Part I Receptive Listen to all three speech models Notice the sound of the initial vowel on the normal speech model Notice the staccato hard onset of the glottal vowel model Then listen carefully for the breathy escape of air Listen Listen Listen all ye all ye out come in all ye all ye out come in all ye all ye out come in free free free If only I ate eggplant If only I ate eggplant If only I ate eggplant instead instead instead Part II Expressive Say each word imitating the model Therapist Note Same as Voicing Therapy Exercise 1 SOAP Note Rules O Same as Voicing Assessment Exercise 1 Clinician Selected Check Boxes A Same as Voicing Assessment Exercise 1 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 30 Module 4 Timing Rate and Rhythm Assessment Exercise 1 Determining Typical Reading Rate Choose a reading passage Read the paragraph aloud using your typical reading rate The Rainbow Passage Fairbanks When the sunlight strikes raindrops in the air they
28. the speech into the Passage box You may play the recording and type simultaneously while transcribing The number of words in the passage will be updated automatically in the Word Count field If you do not transcribe the speech sample you will need to determine the total number of spoken words and enter that number into the Word Count field If you want to save or print the text for later use you must copy and paste it into a word processing document 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 35 To determine Words Correct Per Minute you will need to manually tabulate the number of errors Enter this number into the Errors box The computer will subtract the number of errors from the WPM and report a WCPM in the report When you are satisfied with the speech rate click Next to continue SOAP Note Rules O The client s speech rate in conversational speech was Words Per Minute WPM ina sample of ___ minutes and ___ words The typical speech rate for the age range___ ito__is from ____ ito___ WPM The client s speech rate is typical atypical The client has a slower faster average WPM speech rate ___ of the sample speech were pauses ___ errors were reported in a sample of ___ words spoken with ____ Words Correct Per Minute WCPM __ of the words were produced correctly The client s articulatory rate i e minus pauses in conversational speech was WPM A significan
29. through recording your own speech models The customization feature allows you to tailor the program for specific clients provide regional dialects and let clients use their own voice as the model Overview The program targets seven communication areas modules Breath Support and Loudness Pitch and Intonation Voicing Timing Rate and Rhythm Phonological Accuracy Syllable Stress and Sequencing and Vocal Quality and Resonance The individuals who may benefit from this program are varied in age speech and language skill and medical diagnoses For some individuals it may be more meaningful to practice improving volume and breath support for others phonological or articulation accuracy may be the key to improved communication For example an individual with a repaired cleft palate may have the following priorities for treatment Vocal Quality and Resonance Phonological Accuracy Breath Support and Loudness Voicing Pitch and Intonation LI Timing Rate and Rhythm LI Syllable Stress and Sequencing At the risk of making sweeping generalizations we have pre selected treatment priorities for a variety of diagnoses based on common known features of a medical disorder We recognize that each individual brings vocal strengths and weaknesses to the treatment session so you and your client may add or subtract any of the tasks to help you reach your communication goals We will assume some fundamental knowledge base for both the clinician
30. traveler fold his cloak around him and at last 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 31 the North Wind gave up the attempt Then the Sun shone out warmly and immediately the traveler took off his cloak And so the North Wind was obliged to confess that the Sun was the stronger of the two Total Words in Passage 113 Aesop s Fables The Man the Boy and the Donkey Joseph Jacobs A Man and his son were once going with their Donkey to market As they were walking along by its side a countryman passed them and said You fools what is a Donkey for but to ride upon So the Man put the Boy on the Donkey and they went on their way But soon they passed a group of men one of whom said See that lazy youngster he lets his father walk while he rides So the Man ordered his Boy to get off and got on himself But they hadn t gone far when they passed two women one of whom said to the other Shame on that lazy lout to let his poor little son trudge along Well the Man didn t know what to do but at last he took his Boy up before him on the Donkey By this time they had come to the town and the passers by began to jeer and point at them The Man stopped and asked what they were scoffing at The men said Aren t you ashamed of yourself for overloading that poor donkey of yours with your hulking son The Man and Boy got off and tried to think what to do They thought and they th
31. vocal qualities and resonance of the speaker There are both subjective and objective values to consider when determining what is normal or deviant in vocal quality The physical structure culture and projections of emotion attitude and mood can all subtly and overtly change the vocal quality Score each production Click on the J incorrect counter for each nasal emission then click on the C correct counter to indicate no nasal emission The results page will give a percentage of scored productions Note The computer does not score these the clinician makes the judgment of Correct or Incorrect There should not be a difference between the pinched and unpinched productions If there is there may be velopharyngeal incompetence This is a tool to use to allow you and your client to make those judgments The tasks suggested are typical activities found in Voice textbooks 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 60 SOAP Note Rules O The client produced pinched unpinched word pairs Their unpinched production of the sound had nasal emission of the time Nasal Total Unpinched and their pinched production of the sound had nasal emission of the time Nasal Total Pinched There should not be a difference between the pinched and unpinched productions If there is there may be velopharyngeal incompetence Clinician Selected Check Boxes A Same as Syllable Stress and Sequ
32. 0 10 dB too quiet 11 19 whisper 20 79 normal speaking voice 80 89 party or playground voice 90 and louder too loud Voicing indicates the presence or absence of vocal fold vibration voiced noisy voiceless quiet When the vocal folds vibrate the sound can be described as noisy The vowel sounds are always noisy because the voice is on Some consonant sounds that are noisy are b d g v z Some consonant sounds that are quiet or off are p t k f s A quick way to determine if a sound is noisy or quiet is to feel for a vibration or buzzing on the throat Inspiration Expiration Inspiration is the sound of air going into the lungs The sound of air leaving the lungs or a loud sigh is expiration Rate is a description of the speed of speech A slow rate is typical when the information being spoken is very complex scientific or requires the listener to take time to understand the information A conversational rate varies by speaker situation and topic Some fast talking teenagers can speak with a very rapid pace and maintain intelligibility for their peers but others may have a difficult time understanding them Tables are available in the Timing Rate and Rhythm section 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 74 Pitch is the auditory sensation of a tone that is placed in a scale of high to low The pitch range is the band of notes that a pe
33. 2 Harpist A plucky musician C 2 V 2 Organic Farm Tilling it like it is C 1 V 1 Astronaut A whirled traveler C 2 V 2 Fishing Enthusiast A finatic C5 V 5 Long distance runner A landscape panter C 3 V 2 Astronomy A science over your head SOAP Note Rules O The client s speech for the passage a passage that includes nasal sounds contained nasalized vowel productions on vowels before m n and ng and contained nasal productions on the nasal consonants This indicates that vocal resonance for vowels is Normal Good Fair Poor Impaired and vocal resonance for consonants is Normal Good Fair Poor Impaired Individuals with greater than 10 nasalization of non nasal sounds should be referred to an ENT for evaluation Hypernasality suggests Velopharyngeal Insufficiency Incompetence Velopharyngeal Incompetence VPI is the inability of the velum to close the nasopharynx VPI usually has a physiological origin The nasal snort or posterior nasal fricative may be a functional disorder and may be related to misuse of the velum Individuals with hyponasality for nasal sounds may have an obstruction and are unable to open the nasopharynx sufficiently for breathing and for the production of the m n and ng sounds The cause can be hypertrophic adenoids a narrowed nasopharynx etc and a referral to an ENT is recommended 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 69
34. 6 Hz for women Pitch variations contribute to vocal variety and can clarify and emphasize meaning There are many terms that have been used to describe pitch variations Biphonic means that there are two independent pitches produced One made with the true vocal folds the other with the false folds and there may be a whistling sound as they are produced Diplophonic also has two pitches generally 1 octave apart Intonation is the 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 76 term used to describe meaningful pitch changes they convey context and intention Vocal Fry or Glottal Fry is the term used to describe using a pitch that is too low and gravelly This is often the case for someone who has been speaking too far below their optimum pitch and drops into fry at the end of the sentence This happens when the context of the sentence indicates that there should be a lower pitch to give the correct meaning to the sentence Sometimes the cause is inadequate breath support The individual runs out of air and talks on the residual air Pitch levels that are Too low may also be described as Hoarse this is the sound made when you have laryngitis Gravelly is also used to describe a pitch that is too low Loudness Too high Normal Too low The loudness level is the intensity or amplitude of the waveform The determination of too loud normal or too lo
35. 66 or www LocuTour com Page 27 Module 3 Voicing Assessment Exercise 1 Evaluation of Glottal Stops and Breathiness Take in a breath yawn then exhale with an audible sigh or ah sound to establish optimal pitch Now say the following ae ee ie oe ue oh ah ou 00 oi aye all ye all ye out come in free It s okay I owe you an apology An elephant is enormous I often eat apples I enjoy exciting excursions If only I ate eggplant instead Therapist Note This voicing exercise is designed to evaluate the client s speech for inappropriate glottal stops and breathiness The client will be presented with a phrase in the Model box After they have listened to the model they should click Record in the Practice box and say the phrase themselves When the client has finished recording Speech Visualization will analyze the sound they produced and search for glottal attacks and breathiness Glottal attacks will be highlighted in red and breathiness will be highlighted in yellow Sound that is both glottal and breathy will be highlighted in pink Check and review Speech Visualization s guesses If you see an area marked that shouldn t be select it by highlighting it then click Remove If you want to mark an area as a glottal attack or as breathiness select the area and click the Glottal or Breathy buttons next to Mark As After the appropriate ranges of sound are highlighted Speech Visualization will display th
36. 777 3166 or www LocuTour com Page 52 Therapy Exercise 2 Challenging Words Syllable Stress Sound Sequencing Syllable Sequencing Notice the order of the sounds and the syllable stress You may say the word more than once and score each production as correct or incorrect ll lt lt Restor ome B e 3 theater _ 2 gm p pene Therapist Note This articulation exercise allows the client to make productions then use visual and auditory feedback to monitor correct or incorrect production of target sounds syllable stress and sound and syllable sequencing SOAP Note Rules O The client produced words There were correct productions and incorrect productions Clinician Selected Check Boxes A LI Rate was slow and sequencing was inaccurate LI Rate was slow but sequencing was accurate LI Rate was fast and sequencing was inaccurate LI Rate was inconsistent LI Accuracy was inconsistent 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 53 Therapy Exercise 3 Common Challenging Words for L2 Speakers Say these words Notice the crisp consonants and each vowel sound You may say the word more than once and score each production as correct or incorrect cream flat yet yogurt o apo one Therapist Note This articulation screening exercise is designed to evaluate the client s speech for accurate production of words that are difficult for L2 non native
37. Cancel Quick Start LI Identify the client and update medical and personal information in the profile section of Client Manager Make sure to completely fill out all the fields in the Speech Visualization tab of the client profile This section contains information about age education and puberty Speech Visualization cannot produce accurate normative data if this section is not completed First Name Guest LastName Client First Name Guest Last Name Client Birthdate 01 01 1970 ie Male O Female Birthdate 01 01 1970 ig Male Female Date of Evaluation 11 21 2010 O First Day 11 21 2010 Date of Evaluation 11 21 2010 O First Day 11 21 2010 Show Saved Files Show Sav Medicabinfow Insurance Schedule Notes Speech Visualization Medical info Insurance Schedule Notes Speech Visualization Diagnosis Referring Physician Age Group Grade Level nem Kindergarten pre kindergarten Pre pubescent t a Weer O Grade I rest pubescent W Ciis O Adult Address C perce vaea Acceptable Conversation Volume PAE C Use custom acceptable conversation volumes B Ciis Too quiet below 65 dB Too loudabove 5 dB Current Level of Functioning Optimal Pitch Ranga Use the Pitch Range exercise to calibrate the optimal pitch range From 120 3 Hz To 800 3 Hz Create Report Cox Cancel Create Report Cox Cancel Services Summary
38. Consonants are sounds that are classified according to the place of articulation Palate teeth lips are places of articulation Manner of articulation refers to the air flow Plosives Stops have a complete closure of oral passage of air p b t d k g Fricatives have a forcefulness of air passing through a constricted air space f v th th s z sh zh h Affricates are a blend of a plosive and a fricative ch J Glides have continuous gliding motion semivowels w wh 1 r y Nasals have air passing through the nose Nasalization indicates the presence or absence of nasal resonance m n ng Vowels are speech sounds in which air from the lungs passes through the mouth with minimal obstruction and without audible friction Articulation is the shaping of the vocal tract larynx and pharynx and oral and nasal cavities by positioning the articulators lips tongue palate teeth to stop air or modify air as it passes through the mouth and or nose Syllable is a segment of speech that usually consists of a vowel with or without a consonant sound Every syllable must have a vowel but every syllable does not need a consonant A is a syllable and a word an is a Vowel Consonant syllable Multi syllable or polysyllabic means more than one syllable in a word Baseball is a two syllable word Loudness is a subjective measure of decibel levels The divisions made will be
39. English speakers SOAP Note Rules O The client said the word C Total The production for that word was ____ accurate for ____ trials Clinician Selected Check Boxes A Same as Syllable Stress and Sequencing Therapy Exercise 2 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 54 Therapy Exercise 4 Speech in Context Say this rhythmic passages focusing on articulation of the rapidly alternating sounds Pat a cake Pat a cake Pat a cake pat a cake baker s man Bake me a cake as fast as you can Pat it and prick it and mark it with a B And put it in the oven for Baby and me Total Words in Passage 38 Pussycat Pussycat Pussycat pussycat where have you been T ve been to London to visit the Queen Pussycat pussycat what did you there I frightened a little mouse under her chair Total Words in Passage 28 Hey Diddle Diddle Hey diddle diddle The cat and the fiddle The cow jumped over the moon The little dog laughed To see such sport And the dish ran away With the spoon Total Words in Passage 30 Therapist Note Rapid syllable repetition can be used as a sensitive measurement of oralfacial motor impairment In this exercise the client will attempt to produce rapidly alternating speech sounds in context Make observations concerning the sequencing speed and number of repetitions in addition to the
40. Jola ojlSlsS wm oO z oO beam shy shine mi fim 10 home soup loom coil life an r mg coin oat own o e 5 ga t 8 g d a Therapist Note Same as Syllable Stress and Sequencing Assessment Exercise 2 SOAP Note Rules O The client produced nonnasal nasal word pairs Their production of words without a nasal sound had nasal emission on the vowel of the time Nasal Emissions Total and their production of words with m n or ng had nasal emission on the vowel of the time Nasal Emissions Total This indicates that nasal emission is Normal Good Fair Poor Significant nasal emissions may be indicative of velopharyngeal incompetence an ENT referral may be indicated 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 64 Consistently accurate rarely heard nasality lt 10 Mostly accurate but some assimilation nasality heard in 11 15 Frequently accurate but noticeable nasality 16 25 Infrequently accurate nasality affects communication 26 80 Impaired Inaccurate accurate vocal quality or resonance was not observed gt 1 81 nasal emission Therapy Exercise 2 Speech in Context Say the following passages stress the vowel before any nasal sound m n ng and make an effort to have nasal resonance only on the consonants m n ng Count the number of nasal emissions produced on the vowel preceding the consonant
41. Loss Right Ear 4 frequency average Air Conduction Loss Left Ear 4 frequency average Degree based on pure tone average A The degree of loss for the Right Ear was normal range 0 25 dB mild loss 26 40 dB L moderate 41 55 dB moderate severe 56 70 dB severe 71 90 dB profound 91 dB or gt A The degree of loss for the Left Ear was normal range 0 25 dB LI mild loss 26 40 dB moderate 41 55 dB moderate severe 56 70 dB severe 71 90 dB profound 91 dB or gt A Evaluation of Bone Conduction indicated WNL Bone Conduction indicated a Loss Right Ear Air Bone Gap Left Ear Air Bone Gap Other Observations A Results of the Tympanogram indicated Right Ear Pressure Shape Compliance Left Ear Pressure Shape Compliance A Other Observations of Hearing Acuity 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 88 Structure Oral Peripheral Evaluation The following checkboxes are available to assist in the initial evaluation of the client Oral Peripheral Evaluation Face Face A The oral peripheral evaluation indicated that the face was Symmetrical Normal Asymmetrical and droops to the right LI Asymmetrical and droops to the left _ Other Observations Movement Breathing A The following movement breathing patterns were also observed LI Normal L Grimaces abnormal movements tics Mouth breathing Audible inspiration Tongue p
42. al colors Colors for Timing Rate and Rhythm The computer will automatically highlight what it thinks is speech It will ignore silence at the beginning and at the end of the sample If there is silence inside the speech sample it will identify those areas of silence as pauses This exercise measures how long it takes to read a sample and will separate out the pauses from the speech The speech is highlighted blue and the pauses are highlighted pink This allows the individual the ability to see pauses All speech must have pauses If there is excessive pausing and start and stop speech production you will see an alternating blue and pink pattern If there is excessive pausing there will be excessive pink areas If there is not enough pausing for thought groups then there will be an absence of pink The area from 0 2 seconds was evaluated by the computer as silence before the speaking began and thus not included in the sample The area between 2 6 was normal reading speed with typical pausing The area between 7 9 was a long pause The section between 10s and 20s shows a typical word by word reading rate If you do not want to include a portion of the speech sample exclude it from the highlighted area This will change the Time Rate Pause Time Articulatory Rate and Pause Ratio 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 7 Treatment Sequence Below
43. and the client using these programs The appendix lists some excellent resources for beginning and experienced clinicians The Description of Terms appendix covers some of the terminology used in this manual Individuals with voice and articulation disorders can benefit from visual and auditory feedback of their speech production as well as graphic and numeric information about their approximations and attempts to change vocal output A speech language pathologist familiar with voice disorders may know that the graphic representation of pitch can also give information concerning syllable stress and may choose to use just one graph Others wanting explicit information may want to move between graphs to show different ways of thinking about the fundamental frequency Some individuals obtain a better understanding of the abstract concepts of pitch loudness and quality by seeing numbers some respond better to waveforms and others to meters For this reason we have included multiple ways to view and think about the seven target areas LocuTour s Client Manager is used to access the Speech Visualization program Use the Launch Game button at the bottom right of the screen The dropdown will display all of the LocuTour games that are installed on your computer 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 2 aA Please Log In LocuTour Client Manager Click OK to log in to Client Manager Gor
44. arating colons In this example the time is 1 51 and 22 seconds P M An easy way to find the path on your computer is to open a session in Client Manager and click on the Show Saved Files button The dialog box will show the start of the path on your computer where Speech Visualization files are saved T5 How much room does it take if choose to save all my samples That s not an easy question to answer but we can give you some guidelines We recorded a male and female voice for each of the exercises on the CD except the reading passages and it takes up 230 MB of space During a typical session you might use up 30 50 MB of space on your computer If you have lots of clients and you save each session you could easily run out of space on your computer You can navigate to the directory where Speech Visualization saves the files or use Client Manager find the files and delete the ones you no longer need T5 How do set a Client Manager password Login to Client Manager as you normally would Go to the File menu and select Preferences Type your new password in the Change Password box at the bottom of the window Click OK 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 103
45. are sixteen suggested treatment plans for various diagnoses The treatment sequence may be re ordered or areas omitted for specific clients Voice Disorders Vocal Quality and Resonance Pitch and Intonation Voicing Breath Support and Loudness Timing Rate and Rhythm Syllable Stress and Sequencing Phonological Accuracy Cleft Palate LI Vocal Quality and Resonance Phonological Accuracy Breath Support and Loudness Voicing Pitch and Intonation _ Timing Rate and Rhythm LI Syllable Stress and Sequencing Dysfluencies Voicing Timing Rate and Rhythm Breath Support and Loudness Phonological Accuracy Syllable Stress and Sequencing Pitch and Intonation Vocal Quality and Resonance Deafness Phonological Accuracy th th y ng ch j sh zh h s z t d K g Voicing Vocal Quality and Resonance Syllable Stress and Sequencing Pitch and Intonation Breath Support and Loudness Timing Rate and Rhythm Hard of Hearing LI Vocal Quality and Resonance Phonological Accuracy Voicing Syllable Stress and Sequencing Pitch and Intonation Breath Support and Loudness Timing Rate and Rhythm 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 8 Cochlear Implants LI Voicing Phonological Accuracy L Vocal Quality and Resonance Syllable Stress and Sequencing Pitch and Intonation LI Breath Support and Loudness LI Timing Rate and Rhythm Dialect Differences Phonological Accura
46. assisted exercises will be recorded automatically You may add additional objectives such as carryover activities or non computer exercises that were completed in the session In Client Manager click on the Objective tab for the session and enter the information in the blank space Non speech Sounds and Movements A When non speech sounds occur frequently the communicative message can be overshadowed and unintentional messages about connectedness to the speaker listener communication may be sent During this session the client exhibited LI Belching noises Cough Chronic throat clearing Talking with food in the mouth Hiccup Laugh Lip smacking Body movements LI Sneezing Yawning Place holder um Starter um Loud breathing Sighing Teeth chattering Humming Nasal emissions Idiosyncratic sound effects 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 71 Plan of Treatment P The follow up plan of treatment should LI Provide information and education concerning the clinical findings Determine treatment readiness and assess insight and motivation for change Determine if the client is unwilling or unable to make changes to improve speech then provide information concerning the issues of change Assist client with committing to the need for change Delineate client and clinician goals and roles in treatment Modify abnormalities of posture tone and strength Modify respira
47. ate Articulatory Rate Articulatory Rate Syllables Min Words Min Syllables Min Words Min 116 163 97 136 155 196 129 163 117 183 98 152 159 226 133 188 Co mawo wass srame ras 1 Speaking rate is defined as the number of speech units produced syllables min and includes the pauses in the sample Slow speaking rate below 120 syllables min in high risk children 1 parent with RD may predict future reading disability Pausing times over 1 second in running speech was also reported in children who later presented with a Reading Disorder RD Smith 2006 2 Speaking rate in Words Min was reported by Sturm and Seery for ages 7 9 11 The ratio of 1 2 Syllables per word in Sturm was used to calculate the rate for ages 3 4 and 5 3 Articulatory rate reflects the pace of speech excluding the pauses Converted from Syllables Sec to Syllables Min for ages 7 9 and 11 4 Converted to Words Min using 1 2 Syllables per word Guide Conversational Rates Used in Speech Visualization O Notes Extrapolated from the data in the tables above Age Speaking Rate Articulatory Rate Words Min Words Min 3 5 11 90 150 120 190 6 0 8 11 90 150 160 246 9 0 Puberty 100 160 220 330 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 39 Module 5 Phonological Accuracy Assessment Exercise 1 Screening CVC Say the following CVC word Score the production before moving t
48. below the normal range Clinician Selected Check Boxes A Same as Pitch and Intonation Assessment Exercise 1 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 19 Guide Voice Frequency Range by Age and Sex Age 1 2 340 470 Hz 255 360 255 360 240 340 240 340 3 225 320 230 325 10 11 12 6 po pS 6 Bo Ree OO SD fue a a 13a Pre pubescent 13a Pre pubescent ge TET 30 59 A 60 69 88 235 80 195 170 249 Wilson 1987 Ages 1 18 Stoicheff 1981 Females 50 Guide Voice Frequency Ranges Hz Musical Hz These are the ranges demanded in classical opera hence the decimal point accuracy Husband 1999 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 20 Therapy Exercise 1 Intonation Drills Single Words Say the word with three different pitch ranges Monotone Rising and Falling Monotone Rising Falling Incorrect production Correct production Correct production using only 2 4 tones to convey meaning to convey meaning Therapist Note Intonation drills allow the client to practice saying a specific word or phrase using correct intonation For example Yes Yes and Yes The client should first listen to each model Then they should record their imitation of each model in the practice box When the client has finished recording play back the client s productions and compare them to
49. ble to function in one or more area of ADL s of home work or social life Other Observations Observation of the Client A The client was observed to have LI Clavicular breathing Abdominal breathing Thoracic breathing Shortness of breath Audible breathing Other observations 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 86 Inappropriate Vocal Behaviors or Reinforcers A The client exhibited or reported the following inappropriate vocal behaviors or reinforcers LI Talking over noise Talking too loudly Yelling or screaming Coughing too much LI Crying too much LI Imitating vehicles and animals LI Talking in an unusually high or low pitch Talking excessively even when the client has laryngitis LI Client thinks the funny raspy hoarse voice is acceptable Other people reinforce the client s voice as cute or sexy LI Client gets undue attention for voice disorder Secondary gains apparent for keeping the voice disorder time off less demands etc LI Reports stressful or tension filled life LI Frequent bouts of laryngitis LI Chronic throat clearing 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 87 History Hearing Acuity Hearing Acuity A Hearing Acuity was not tested appears normal possible hearing loss referral indicated A Hearing Acuity was tested Air Conduction WNL Air Conduction
50. coding Noticeable omission of punctuation and appropriate phrasing Accurate reading due to slowed reading rate Tone LI Appropriately slow and sad for context LI Inappropriately slow and sad for context LI Appropriately bright fast and cheery for context LI Inappropriately bright fast and cheery for context LI Inappropriately boring for context Miscues and Reading Errors LI Comprehensive reading evaluation is indicated Multiple self corrections LI Used finger to keep place Frequently lost place Disregarded punctuation Frequent omissions additions reversals of sounds and or syllables Frequent omissions additions reversals of whole words and or phrases Poor enunciation mumbling Stuttering like Dysfluencies LI Part word repetition Whole word repetition Secondary facial or body movements Appears to anticipate dysfluency Avoids speaking Assessment Exercise 2 Determining Typical Speech Rate Speak in a conversational tone for one minute Enter in the number of words spoken in that minute to determine your speaking rate Therapist Note The client should record a speech sample for approximately one minute Speech Visualization will determine the exact length of time the client spoke and calculate their rate in Words Per Minute WPM Speech Visualization will ignore silence at the beginning and end of the recording so you do not need to edit the sound yourself After the spoken sample is complete the clinician may transcribe
51. counted as one sound and vowel R is counted as a vowel sound You may change the counts for each paragraph on the sidebar The Zoo Passage C 10 V 6 Look at this book with us C 7 V 8 It s a story about a zoo C 7 V 5 That is where bears go C 12 V 8 Today it s very cold out of doors C 10 V 8 but we see a cloud overhead C 13 V 8 that s a pretty white fluffy shape C 10 V 6 We hear that straw covers C 7 V 4 the floor of cages C 7 V 6 to keep the chill away C 7 V 4 yet a deer walks C 6 V 3 through the trees C 6 V 4 with her head high C 10 V 5 They feed seeds to birds C 7 V 6 so they are able to fly 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 62 SOAP Note Rules O The client s speech for The Zoo Passage a 72 word passage that eliminates nasal sounds contained vowel nasal emissions ____ and consonant emissions This indicates that vocal resonance for vowels is Normal Good Fair Poor Impaired and vocal resonance for consonants is Normal Good Fair Poor Impaired Individuals with greater than 10 nasalization of non nasal sounds should be referred to an ENT for evaluation Clinician Selected Check Boxes A Same as Syllable Stress and Sequencing Assessment Exercise 1 Assessment Exercise 5 Counting 60 100 Mason and Grandstaff 1971 Say the following group of numbers Count the number of nasal emissions After the client has complete
52. cy Voicing Syllable Stress and Sequencing LI Pitch and Intonation L Timing Rate and Rhythm LI Vocal Quality and Resonance LI Breath Support and Loudness Articulation Disorders LI Phonological Accuracy O Voicing Syllable Stress and Sequencing l Vocal Quality and Resonance Timing Rate and Rhythm Pitch and Intonation Breath Support and Loudness Parkinson Disease Breath Support and Loudness Timing Rate and Rhythm Phonological Accuracy LI Vocal Quality and Resonance Voicing LI Pitch and Intonation LI Syllable Stress and Sequencing Traumatic Brain Injury Breath Support and Loudness Timing Rate and Rhythm Vocal Quality and Resonance Phonological Accuracy Syllable Stress and Sequencing Pitch and Intonation Voicing Dysarthria _ Timing Rate and Rhythm LI Phonological Accuracy Breath Support and Loudness 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 9 _ Vocal Quality and Resonance Syllable Stress and Sequencing Pitch and Intonation Voicing Apraxia LI Phonological Accuracy L Timing Rate and Rhythm Voicing Syllable Stress and Sequencing Vocal Quality and Resonance LI Pitch and Intonation LI Breath Support and Loudness il Syndrome Pitch and Intonation _ Syllable Stress and Sequencing Timing Rate and Rhythm Phonological Accuracy Breath Support and Loudness Vocal Quality and Resonance Voicing Prosodic Speech Disorders Pi
53. d Vocational History A The client reports LI Current or previous employment as as teacher public speaker cheerleader singer or salesperson LI Employment or vocation LI Significant stress in the home at work or interactions with others Recent significant loss of spouse parent child or friend 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 85 History of the Communication Disorder Professional Voice training or SLP Intervention A Professional voice training or SLP intervention was Never received Received but not practiced Received but not completely successful Other Observations Client s description of the communication disorder A The client s description of the communication disorder included LI Possible causes Related surgeries Current level of stress Previous treatments General health Other Observations Situations that make the symptoms A The client reported situations that made the situation LI Better Worse Other Observations Client s rating of the functional impact of the communication disorder on their daily life A The client rated the functional impact of the communication disorder on their daily life as LI None Minimal Tolerable Mild Affects home work or social life Moderate Affects more than one area Severe Significantly impacts ADL s Activities of Daily Living Profound Not a
54. d from http www Voiceproblem org Campbell T F amp Dollaghan C A 1995 Speaking rate articulatory speed and linguistic processing in children and adolescents with severe traumatic brain injury Journal of Speech and Hearing Research 38 864 875 Chamberlin S L amp Narins B 2006 Dysarthria Encyclopedia of Neurological Disorders Thomson Gale 2005 Retrieved from http health enotes com neurological disorders encyclopedia dysarthria Christenfeld N 1996 Effects of a metronome on the filled pauses of fluent speakers Journal of Speech and Hearing Research 39 1232 1238 Daniels S K McAdam C P Brailey K amp Foundas A L 1997 Clinical assessment of swallowing and prediction of dysphagia severity American Journal of Speech Language Pathology 6 17 23 Darley F L Aronson A E amp Brown J R 1975 Motor speech disorders Philadelphia Saunders Deem J F amp Miller L 2000 Manual of voice therapy 2nd ed Austin ProEd Dworkin J P amp Meleca R J 1997 Vocal Pathologies Diagnosis Treatment and Case Studies San Diego Singular Publishing Group Inc Eckel F C amp Boone D R 1981 The S Z ratio as an indicator of laryngeal pathology Journal of Speech and Hearing Disorders 147 149 Fairbanks G 1960 Voice and articulation drillbook 2nd ed New York Harper and Row Fairbanks G 1940 Recent studies of fundamental vocal pitch in speech The J
55. d strained gruff voice 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 75 Strident describes a narrow ranged high pitch sharp and metallic voice Hoarseness is a raspy harsh grating sound made by irregular vocal fold vibration and escaping glottal noise Whisper or the whispered voice has an unnaturally low volume that may indicate weak breath support or vocal pathology if the individual is unable to raise the volume of the voice by choice Breathiness is used to describe when vocal cords are vibrating but there is also air escaping through the glottis causing turbulence Roughness is an irregularity of the voice source which is measured by the irregular fluctuation of the fundamental frequency Terms used to describe roughness include Too Harsh Irregular voicing Laryngeal Creaky Tremor Strain and muscular tension produces effortfulness and excessive energy in the laryngeal area Some describe it as forced or pushed Running out of breath can also produce a laryngeal strain Terms used to describe roughness include Too high pitched Strangled Tense Dysarthric quality is a result of impaired motor muscular control of the speech mechanisms It is often breathy slow with limited pitch range The breathiness may be from the weak musculature or the weak breath support or irregular phrasing due to running out of air There are many types of dysarthria Nasality is used to
56. d their production enter the number of nasal productions Numbers 60 901 Therapist Note The 60 s have high pressure consonants that could be difficult for those with velopharyngeal incompetence A score of 0 would indicate no assimilation nasality and a score of 4 or more would indicate noticeable nasality The 70 s are heavily loaded with nasal sounds and the vowels may show assimilation nasality This will be the most difficult group to score as it is not an all or nothing score You should hear nasality on the seventy portion but not on the one two three etc Score the second part of the production for nasality The 80 s should sound normal if there is no problem with velopharyngeal closure The 90 s should sound normal because both typical speakers and those with closure problems will produce these nasal sounds the same SOAP Note Rules O The client s speech for numbers 60 68 contained nasal emissions This indicates that vocal resonance is The client s speech for numbers 70 78 contained nasal emissions This indicates that vocal resonance is The client s speech for numbers 80 88 contained nasal emissions This indicates that vocal resonance is The client s speech for numbers 90 98 contained nasal emissions This indicates that vocal resonance is Normal Good Fair Poor Impaired Significant nasal emissions may be indicative of velopharyngeal incompetence Clinician Selected Check Box
57. describe speech that has resonance in the nose for sounds usually made orally The air is escaping through the nose Hypernasal speech has excessive sound resonating in the nasal cavity The sounds that are supposed to be produced using nasal resonance are m n and ng When vowels or other consonant sounds resonate in the nose most listeners perceive this to be Hypernasal Denasality is used to describe speech that stops air from going through the nose on the typical nasal sounds of m n and ng Hyponasality is the term used to describe this type of cold in the nose sound Other common terms are twangy and denasal Monotone Individuals that demonstrate problems with prosody have been described as having robot like speech or speak in a monotone with a very limited pitch range 4 or less notes Sometimes the stress is inconsistent with the intention of the sentence or there are pauses in unexpected places and rapid speech where pauses were anticipated Treatment should include complete exercises to increase awareness imitate the typical production of sounds without over or under articulation place correct stress on the target syllables make appropriate pausing between words and content meaning groups match the rate quality and loudness of the modeled speech Pitch Too high Normal Too low The mean fundamental frequency for pitch based on age gender and referent culture is 128 Hz for men 25
58. dia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 82 Vocal Hygiene Exercises E a a a a SMITTES Good posture during all exercises Stand or sit tall with both feet flat on the a Pull your shoulders back to open up your chest L A E E Ce RE 1 Warm up by saying u hum or m hm You may expand to u hum one u hum two u hum three etc 2 Glide up e down the scale with easy onset vowels ah ee oh oo ie Glide low to high pitch 5 times then high to iow pitch 5 dines This exercise will increase your pitch range which will aid in inflection 3 Shoulder Shrug Inhale as you lift your shoulders towards your ears Hold for a count of five Feel the tension Then exhale as you pull your shoulders downwards Feel the stretch in your neck and shoulders Repeat 5 times This exercise stretches the muscles that extend from the base of your skull to the top of your shoulders 4 Slowly rotate your shoulders in a circular motion Inhale as you raise your shoulders and exhale as you lower them Do five forward circles and five backward circles Feel the stretch in your shoulders upper chest and upper back 5 Let your head slowly fall forward Keep your chin to your chest for 10 15 seconds Rotate your head to the left and right holding each side for 10 15 seconds Support your head with your hand in order to not over stretch your side neck muscles Repeat all three positions 5 times 6 Slowly
59. ding Singing Pitch Range before you can do Dx3 Finding Pitch Range in Context Setting the lower limit Take in a breath then yawn with an audible ah sound Lower your pitch one note for each number as you count down the scale ah four three two one Typical range is 12 notes you may add more Therapist Note The Pitch Range exercise allows you to determine your client s pitch range It has two components the upper and lower limits In the lower limit portion of the exercise clients will exhale with an audible sigh to get them to start at their optimal pitch They will then count down the note scale from four to one The client may add lower notes if they choose Speech Visualization will attempt to find the lowest note and use it to determine the lower limit of the client s pitch range Alternately you may select the portion of the sound containing the spoken number one or the lowest tone Speech Visualization will use your selection to calculate the lower limit of the client s pitch range You may choose to include or exclude vocal fry The lower limit is displayed next to the Record button If you are satisfied with Speech Visualization s determination you can click Next at this point to continue If you are not satisfied you can select a portion of sound for Speech Visualization to use to calculate the lower limit You should select the last note or the one and try to limit your selection to the part whe
60. e for 30 60 seconds This exercise will reduce tension in your jaw 11 Using one or two fingers on your bottom teeth gently pull your bottom jaw downward Let your jaw completely relax and do not resist the movement Repeat 5 times holding each stretch for 5 10 seconds This exercise as well as 10 are good exercises to do in the shower Warm water hitting the muscles increases flexibility 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 84 History Voice Disorders Intake Checklist The following checkboxes are available to assist in the initial evaluation of the client Medical Records Medical Records A Medical records indicate LI Subglottal stenosis LI Vocal fold nodules on one or both cords Vocal fold polyps Vocal cord paralysis Contact ulcers on the vocal cords Papilloma Laryngeal papillomatosis LI Intracordal cysts LI Sulcus vocalis LI Vascular ectasia Cancer Edema Hemangioma Laryngeal or Interarytenoid cleft Other cleft Laryngeal trauma GERD Gastroesophageal Reflux Disease Dysphagia Stroke Brain Injury Medical History Medical History A Medical history includes LI Smoking quantity Thyroid disease Caffeine use and or tea tannins Phonotrauma Overuse misuse abuse of voice Caustic chemical ingestion Overuse of eucalyptus or other drying agents Overuse of alcohol L Recent surgery Physical trauma to the neck or throat Family an
61. e overall glottal and breathy percentages to the right of the graph Review these then click Next when you are ready to continue SOAP Note Rules O In the ___ seconds of the combined speech samples the client made ___ glottal attacks __ of the sample contained glottal attacks ___ sec and ___ of the sample was breathy ___ sec Clinician Selected Check Boxes A The characteristics observed were LI Excessive Glottal Attack LI Excessive Breathiness for age sex culture LI Inconsistent production of normal speech 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 28 Therapy Exercise 1 Receptive and Negative Practice Glottal Stops Part I Receptive Listen to all three speech models Notice the staccato hard onset of the glottal vowel model incorrect Notice how the smooth h sound facilitates an easy onset for the vowel H vowel Notice the sound of the initial vowel in the easy onset speech model correct Vowel first Vowel first H vowel Vowel first incorrect with glottal to facilitate a smooth correct relaxed air attack vowel stream no glottal attack Listen Listen Part II Expressive Say each word imitating the easy onset model Therapist Note The Receptive and Negative Practice exercise presents a word in three different ways incorrectly with a glottal vowel with an initial h sound to model easy onset of the vowel and correctly On
62. e words or phrases Speech Visualization will prompt you to select words or phrases to present to the client LI Click the checkboxes next to the items you wish to present LI When you have selected all of the sounds for this session the session will begin LI The exercises are presented in the order that they were selected L Practice imitating new speech patterns Pitch loudness etc LI Compare and contrast speech using the speech visualization tools LI Evaluate the speech using the on screen rating scales LI Make notations using the Assessment Notes button LI Save samples if desired using the Save Recording button The Back button allows you to return to previous screens Using the back button will delete the scoring for all pages that you go back thru You will not lose your A Notes if you go back LI After the last exercise is completed the Session Summary page appears LI Click Finish to return to Client Manager and complete the SOAP notes LI Print reports for your files or for submission to insurance companies Interpreting the Speech Sample The sounds are displayed in the recording box as they are being spoken The sound level meter is the vertical bar on the right You want to speak loud enough to have the bar go up to the green area If you speak too loudly the bar will go all the way to the red area if you are too quiet it will rise only to the pink area 2007 2010 LocuTour Multimedia Inc All Rights Re
63. ection E Gen E EEA I To amp 6670 Hz 4800 Hz 3460 Hz 85 dB__ 2490 Hz 1790 Hz 800B__ 1290 Hz 75dB_ 930 Hz OdB 670 Hz 480 Hz 350 Hz 250 Hz 180 Hz 130 Hz 90 Hz 60 Hz Cc _ _ _ _ Fe ase a eae e Colors for Pitch and Volume In some games there is a green line The green line represents the pitch The lower the line on the sound box the lower the pitch You can estimate the pitch by looking at the numbers on the left of the sound box labeled with Hz for Hertz If there are breaks in the green pitch line that indicates that the computer did not pick up any sound and you were either silent or not speaking loudly enough to have the sound register You may either speak louder or return to the calibration page and reset the calibration to a smaller number perhaps 20dB or lower for very quiet speakers Colors for Glottal Stops and Breathiness Module 3 evaluates breathiness and glottal stops The computer can assist you in the assessment of glottal and breathy speech but does not substitute for clinical assessment of the sample The yellow highlight indicates that the computer picked up a significant amount of air or breathiness The pink highlight shows where there was a sudden drop in the fundamental frequency f0 which indicates a 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 6 glottal stop You can adjust the computer s interpretation of the s
64. encing Assessment Exercise 1 Assessment Exercise 3 i u ee oo Contrast Say the following vowel sounds with pinched and unpinched nostrils It is okay to alternate between a pinched nose closed production and an open nose production Click on the Z incorrect checkbox for each nasal emission then click on the C correct checkbox to indicate no nasal emission There should not be a difference between the pinched and unpinched productions If there is there may be velopharyngeal incompetence Unpinched Pinched ee 00 00 ee 00 ee 00 ee 00 00 Therapist Note Same as Syllable Stress and Sequencing Assessment Exercise 2 SOAP Note Rules O The client produced the sounds ee 00 ee 00 ee oo Their unpinched production of the sound had nasal emission of the time Nasal Total Unpinched and their pinched production of the sound had nasal emission of the time Nasal Total Pinched There should not be a difference between the pinched and unpinched productions If there is there may be velopharyngeal incompetence Clinician Selected Check Boxes A Same as Syllable Stress and Sequencing Assessment Exercise 1 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 61 Assessment Exercise 4 Paragraph Test Read this paragraph aloud using your typical speech All nasal consonants are excluded Count the number of nasal emissions produced on the vowel sounds and
65. ent Normal _ included Grinding and or Popping Other Observations of the jaw Oral Peripheral Evaluation Palate A Evaluation of the Hard and Soft Palate indicated Color LI Normal color LI Abnormal color Arch LI Normal arch High arch LI Low arch Wide arch LI Narrow arch Growths No growths LI Growths present _ Location of growths Fistula No fistulas Li Fistulas present Location of fistulas 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 91 Cleft No clefts Repaired clefts Location of repaired clefts Unrepaired clefts present Location of unrepaired clefts A Soft Palate symmetry at rest was Normal symmetrical soft palate symmetry at rest Bifid soft palate symmetry at rest LI Asymmetrical uvula deviates to the right L Asymmetrical uvula deviates to the left A Soft Palate symmetry on Ah was L Normal symmetrical soft palate symmetry on Ah Asymmetrical uvula deviates to the right on Ah Asymmetrical uvula deviates to the left on Ah A Nasality was Normal L Hypernasal LI Hyponasal A Gag Reflex was LI Normal Hyperactive L Hypoactive LI Absent A Other Observations of the palate Oral Peripheral Evaluation Tongue A Evaluation of the tongue indicated Tongue Size Normal tongue size _ Large tongue size L Small tongue size Tongue Tone Normal tongue tone L Flaccid tongue tone L Fasciculations spasms wri
66. enter in Nasal on Vowel Count the number of nasal emissions produced on any consonant sounds and enter in Nasal on Consonant The Zoo Passage Fletcher 1972 Look at this book with us It s a story about a zoo That is where bears go Today it s very cold out of doors but we see a cloud overhead that s a pretty white fluffy shape We hear that straw covers the floor of cages to keep the chill away yet a deer walks through the trees with her head high They feed seeds to birds so they are able to fly Total Words in Passage 72 Therapist Note These exercises will allow you to evaluate the vocal qualities and resonance of the speaker There are both subjective and objective values to consider when determining what is normal or deviant in vocal quality The physical structure culture and projections of emotion attitude and mood can all subtly and overtly change the vocal quality As the client says the paragraph keep track of the nasal emissions the computer does not score these productions Enter the number of nasal emissions for consonants and vowels in the boxes on the sidebar The results page will give a percentage of scored productions for the nasal emission on the consonants and on the vowels The passages we have selected do not have nasal consonants in standard American English though they may in regional dialects The following is our count of consonants and vowels for each passage Note ch th wh etc are
67. er May I have one Are you sure itsa What wonderful news pee reese neon eda eee That s alright Is it today You must be That looks interesting ee EIN tidings METRES Il be great Therapist Note Same as Pitch and Intonation Therapy Exercise 1 SOAP Note Rules O Same as Pitch and Intonation Therapy Exercise 1 Clinician Selected Check Boxes A Same as Pitch and Intonation Assessment Exercise 1 Therapy Exercise 4 Contrasting Pitch One Target Word in Sentence Screen 1 Say the following using a normal tone of voice Screen 2 Say the following placing stress on the word in italics 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 22 The first sentence uses the target word in an unstressed context The second sentence stresses the target word and the stress adds to the meaning of the sentence Therapist Note Example of Contrastive Stress Drill It is possible to change the meaning of a sentence by changing the stress emphasis on a word It is my new dress It is my new dress In this exercise the client will learn to distinguish between normal intonation and stressed intonation to convey meaning The client is first presented with a sentence in a normal tone of voice Click Record and imitate the model sentence When they have finished recording compare their production to the model Score the client s production using the C or J buttons Correct Incor
68. es A Same as Syllable Stress and Sequencing Assessment Exercise 1 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 63 Therapy Exercise 1 Using the Soft Palate on Nasal and Non nasal Sounds Say the following pairs of words Stress clean non nasal production of the vowel before any nasal sound m n ng Make an effort to have nasal resonance only on the consonants m n ng not on the adjacent vowel Click on the incorrect counter for each nasal production of a vowel sound and click on the C correct counter to indicate no nasal emission on a vowel sound Since this is a therapy activity multiple productions may be scored Hypernasality If you hear a shift in tone between the two productions then the sound is resonating in the nose Typical speakers resonate less than 10 20 of the oral sounds in the nose Consistent frequent nasal resonation is called hypernasality The only three English speech sounds that have nasal resonance are m n ng Fle gt an n o m am cl O S t g ip t ut ll ng ng O 4 fas Q go z o wln a So o a S D nr E o 5 sat sang Cc re can n e b wiel lt n kit king 5 sa ra i sin pod pons plane ru u O hi n T a 3 eR g 5 o u B h P c i g d ch g c i an 3 i fom ERRE 05 c i r i l r game
69. f the consonantal substitution pattern Phonology and speech remediation Walsh H H Ed Houston College Hill Press Stoicheff M L 1981 Speaking fundamental frequency characteristics of nonsmoking female adults Journal of Speech and Hearing Research 24 437 441 Sturm J A amp Seery C 2007 Speech and articulatory rates of school age children in conversation and narrative contexts Language Speech and Hearing Services in Schools 38 47 59 Traunmiiler H amp Eriksson A 1995 The frequency range of the voice fundamental in the speech of male and female adults Retrieved from www _ling su se staff hartmut aktupub htm University of Aberdeen 2006 The grandfather passage and The north wind and the sun passage Retrieved from http www abdn ac uk langling resources Standardised 20reading 20passages doc Wilson D K 1987 Voice problems of children 3rd ed Baltimore Williams and Wilkins Zellner B 1994 Pauses and the temporal structure of speech in E Keller Ed Fundamentals of speech synthesis and speech recognition 41 62 Chichester John Wiley 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 80 Voice Care and Treatment Environmental Interventions gt Change things at work home sibling rivalry gt Avoid noise and smoke gt Get away from noise move self gt Talk in small groups gt Sit closer to the listener gt Diaphragmatic
70. fice a Mac friendly version of OpenOffice from www neooffice org or Bean a small easy to use word processor available for free at http www bean osx com T4 The program does not highlight sound or report pitch information properly Speech Visualization needs to know what the noise level in the room is in order for it to tell what is speech and what is silence If you are using a noisy computer with a built in microphone the noise level of the fans and hard drives might overwhelm the speech level Use the Calibration Wizard to let Speech Visualization know about the noise in the room You can also run into problems if you are close to heating cooling vents and the fan starts up We recommend that you use a headset microphone combination similar to those used by phone operators to minimize extraneous sounds T4 saved the sound samples but now can t find them Speech Visualization saves the sound samples in the Client Manager folder The path to a specific sample would be Data Client Name Saved Data Communication Area Game Word As an example 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 102 if you had a client named Sara who produced the word cake in the Screening CVC exercise the speech sample would be saved in the file Client Manager Data Sara Saved Data Phonological Accuracy Dx 1 cake 2010 08 02 135122 They should be sorted by date and time Note The time is given without the sep
71. ficient movement to remove food particles from mouth LI Tongue motility problems contribute to oral stage dysphagia 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 93 Tension Sites Tension Sites A Musculature tension was evaluated at the following sites Face LI Facial tension present Facial tension absent Mandible Mandible tension present LI Mandible tension absent Neck _ Neck tension present Neck tension absent General Body LI General body tension present LI General body tension absent A Other Observations of Tension Sites 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 94 Risk Assessment GERD or LRD Indicators of GERD or LRD Gastroesophogeal or Laryngeal Reflux Disease Friedman 2006 A Follow up evaluation or screening by a physician for a possible reflux disorder is indicated The following symptoms were reported or observed in the course of treatment LI Heartburn A feeling of a lump in the throat Burning sensation when swallowing Nighttime choking coughing episodes Black tar like stools Loss of voice Asthma like reactions Chest discomfort Persistent cough rhinitis Inspiratory stridor noise when breathing in Recent Upper Respiratory Infection URD with lingering symptoms Stridor worse with increased activity or feeding LI Noisy breathing while sleeping Mouth breathing Regurgitati
72. g so you do not need to edit the sound yourself If the client wasn t able to finish reading the passage you can edit the text in the Passage box to remove the portion of the text they didn t read The word count and rate will automatically change accordingly If you choose Custom Passage when you select passages you can type a passage for your client to say or read into the text block You can also cut and paste from a word processor The word count will automatically be updated Have the client read or speak the passage If you want to determine Words Correct Per Minute you will need to manually tabulate the number of errors Enter this number into the Errors box The computer will subtract the number of errors from the WPM and report a WCPM in the report When you are satisfied with the reading rate click Next to continue O The client s reading rate was Words Per Minute WPM in a sample of ___ minutes and ____ words of the sample speech were pauses The client read words correctly out of total words with a rate of Words Correct Per Minute WCPM of the words were produced correctly The typical reading rate for an adult or a student in grade is to WPM The client s reading rate of is typical atypical The client has a slower faster average reading rate An adult typically reads between 140 and 180 WPM however when the material is serious or technical the reading rate is typically 140 WPM Faster reading rates
73. ge 66 Therapist Note These exercises will allow you to evaluate the vocal qualities and resonance of the speaker There are both subjective and objective values to consider when determining what is normal or deviant in vocal quality The physical structure culture and projections of emotion attitude and mood can all subtly and overtly change the vocal quality As the client says the paragraph keep track of the nasal emissions the computer does not score these productions Enter the number of nasal emissions for consonants and nasalized vowels that precede a nasal consonant in the boxes on the sidebar The results page will give a percentage of scored productions for the nasal emission on the consonants and on the vowels that precede a nasal consonant There should be nearly 100 nasalization for m n ng i e Nasal on Consonants and there should be less than 10 nasality on the vowels preceding m n ng unless there is a regional dialect that includes more Hypernasality suggests velopharyngeal insufficiency and Hyponasality suggests an obstruction of the nasopharynx A referral to an ENT is indicated for both issues The following is our count of consonants and vowels for each passage based on their pronunciation in Standard American English they may vary in regional dialects You may change the counts for each paragraph on the sidebar The Muffin Man C 5 V 4 Oh do you know the muffin man C 8 V 6 The muffin man the muffin man
74. he session click the Save all recordings automatically checkbox A typical session might use between 30 and 60 MB of space LI Click Next and the Select Exercises screen will appear 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 4 amp Client Manager Rete FM 100m ThuOct14 2 41PM Q eoo LocuTour Speech Visualization Guided Session Select Exercises Select the exercises for today s treatment plan Today s Treatment Plan Exercises Module 1 Breath Support and Loudness Dx 1 S Z Ratio Task Y Module 1 Breath Support and Loudness Module 2 Pitch and Intonation Dx 3 Finding Pitch Range in Context I Dx 1 S Z Ratio Task Module 2 Pitch and Intonation Tx 3 Intonation Drills Sentences Mixed T Dx 2 Sustaining Vowels Module 3 Voicing Tx 1 Receptive and Negative Practice Glottal Stops A Dea iaie Manse opie Module 4 Timing Rate and Rhythm Dx 2 Determining Typical Speech Rate Module 5 Phonological Accuracy Dx 1 Screening CVC D Tx 1 Maintaining Appropriate Volume Module 6 Syllable Stress and Sequencing Dx 1 Syllable Sequencing Diadochokinesis Tx 2 Developing Improved Breath Support Module 7 Vocal Quality and Resonance Dx 1 Nasal Resonance Y Module 2 Pitch and Intonation 5 Dx 1 Finding Optimal Pitch 5 Dx 2 Finding Singing Pitch Range Dx 3 Finding Range in Context Falling Rising Mixed C Sarcastic E Tx 4 Contrasting Pi
75. iet for conversational speech As measured by the Speech Visualization program Results may vary with different microphones O The decibel range was from ___ dB to___ dB __ of the sample was in the too quiet range _ of the sample was in the too loud range and __ of the sample was at an appropriate speaking volume Clinician Selected Check Boxes A Characteristics observed were Loudness LI Overall whole utterance is too soft LI Overall whole utterance is too loud LI Too much fluctuation LI Inappropriate LI Single words in sentences are too loud or too quiet and interfere with the whole message being communicated LI Sentences start out with appropriate loudness but by the end of the sentence the volume drops off and the final portion is unintelligible LI Sentences start out with appropriate loudness but by the end the person is pushing out the sentence on reserve air and didn t plan ahead for the length of the sentence Voice sounds strained or drops to vocal fry LI Unable to emphasize words in a sentence by increasing the loudness LI Changing physical position improves volume LI Responds positively to external cueing LI Does not respond to external cueing Absent no vocalization observed Respiration LI Forced expiration inspiration L Grunt at end of expiration LI Audible inspiration Li Initiated respiration at an atypical point in the respiration cycle L All pauses contain inspiration LI Exaggerated respiratory move
76. ing from the front of the van Matilda Jane smiled I m Matilda Jane Maybe you might like to come running and jumping and merry making with me on Monkey Song Lane she said Never muttered the Mastiff I don t want a mutt around me So while the Mastiff sat making angry noises and being mad Matilda Jane was singing and dancing down Monkey Song Lane and never had a nice mutt had a nicer time being a mutt Kalamazoo An old man from Kalamazoo Once dreamed he was eating his shoe He awoke late that night In a terrible fright Now instead of one tongue he has two Quotes I never did a day s work in my life It was all fun Thomas Edison Every morning I get up and look through the Forbes list of the richest people in America If I m not there I go to work Robert Orben Mama exhorted her children at every opportunity to jump at the sun We might not land on the sun but at least we would get off the ground Zora Neale Hurston Definitions Rattlesnake A tattle tail Caterpillar An upholstered worm Zebra A horse behind bars Big Ben The tock of the town Acrobats People who turn a flop into a success Harpist A plucky musician Organic Farm Tilling it like it is Astronaut A whirled traveler Fishing Enthusiast A finatic Long distance runner A landscape panter Astronomy A science over your head 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Pa
77. llable stress and sequencing practice might require a different approach for individuals with fluency disorders Li Part word repetition Whole word repetition Secondary facial or body movements _ Appears to anticipate dysfluency Avoids speaking 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 56 Guide Description of Articulation Phoneme Contrasts These are practical categories that may be used to communicate a place and manner of articulation to the student and are not to be considered a distinctive feature analysis There are many fine textbooks that cover this topic Speech consonant sounds that require mostly Lip movement or strength Tongue tip movement or strength Mid tongue movement or strength Back tongue movement or strength Popping or pushing air movement Smooth consistent air movement f v th th s z sh zh w h wh 1 r m n ng Back tongue and lip movement kw qu ks x Resonance in the mouth oral cavity p b t d k g f v th th s z sh zh ch j l r w h wh kw ks Resonance in the nose nasal cavity m n ng Speech vowel sounds High vowel sounds tongue fronting and lips ee i e smiling Mid vowel sounds tongue flattening and lips ae a u opening jaw moving down Back vowel sounds tongue bunching up in the o UU 00 back with lip rounding Sliding vowel sounds multiple movements for ie Ue oi OY OU OW y one sound
78. ments LI Produces few words per breath Li Improves respiration with position change LI Unaware of speech breathing pattern Stridor audible breathing as a result of LI Asthma LI Nasal blockage LI Laryngeal neoplasms LI Laryngeal webs LI Vocal fold abductor weakness or paralysis 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 14 Guide Loudness Perception Sound pressure levels SPL Decibel is a log scale A 3dB increase is a doubling of the actual sound energy 10dB represents a ten fold increase However to complicate matters the human ear is not linear and perceives a 10 dB increase as a very approximate doubling of volume Husband 1999 McAfee 1998 Note that the measurement of Sound Level by Speech Visualization when speaking into a microphone 1 inch from your mouth will be significantly higher that the Sound Level perceived by a person sitting next to the speaking individual since Sound Level attenuates significantly with distance from the source Sound level dB 10 dB 0 dB 10 dB 20 dB 30 dB 40 dB 50 dB 60 dB 70 dB 80 dB 90 dB 95 dB 100 dB 110 dB 120 dB 125 dB Approximate observed equivalent Hypersensitive hearing Sound proof room threshold of normal hearing Rustle of leaves in a breeze normal breathing sounds f s th Whisper watch ticking sounds z v p h g K Quiet conversation average home noises sounds ch sh Conver
79. nant of the time the medial vowel was incorrect of the time and the final consonant was incorrect of the time Clinician Selected Check Boxes A Characteristics also observed were Speech was unintelligible Speech characterized by weak articulatory contacts Speech was very difficult to understand Speech in conversation is significantly poorer than in isolation Speech was consistently accurate Speech was intelligible with careful listening Speech was mostly accurate but errors were observed Speech was frequently accurate but noticeably in error Speech was infrequently accurate but occasional accuracy was possible Speech contained multiple sound omissions deletions and or substitutions LI Speech characterized by vowelization Gestures supplemented speech Tongue protrusion Mouth open at rest Speech improved with external prompting Types of Errors LI Initial Consonant errors LI Medial Consonant errors Final Consonant errors LI Vowel production errors Evaluation of consonant clusters is indicated as observed in conversational speech Phonological Process Errors LI Vowel production errors L Syllable reduction LI Cluster reduction Prevocalic singleton obstruent omissions LI Postvocalic singleton obstruent omissions Stridency deletion LI Velar deviations Liquid 1 deviations LI Liquid r e deviations LI Nasal deviations Glide deviations 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www
80. ntial diagnostic sign of damage to the cranial nerve XII Articulation imprecision Hypernasal voice Hoarse Breathy vocal quality Slow labored speech rate Swallowing problems may occur Mixed Dysarthrias Simultaneous damage to two or more primary motor components of the nervous system Spastic flaccid Dysarthria A The client exhibited the following symptoms consistent with Spastic flaccid Dysarthria LI Imprecise consonants Hypernasality Harsh voice quality Slow rate LI Monopitch Short phrases LI Distorted vowels Low pitch Monoloudness Excess and equal stress Prolonged intervals Spastic ataxic hypokinetic Dysarthria A The client exhibited the following symptoms consistent with Spastic ataxic hypokinetic Dysarthria LI Upper Motor Neuron cerebellar extrapyramidal LI Reduced stress and intonation Monopitch Imprecise consonants Slow rate Excess and equal stress Low pitch Irregular articulatory breakdown Spastic ataxic flaccid Dysarthria A The client exhibited the following symptoms consistent with Spastic ataxic flaccid Dysarthria LI Upper Motor Neuron cerebellar Lower Motor Neuron Irregular articulatory errors Irregular difficulty with rate quality harshness Variable spasticity Slow movement Limited range of movement Inaccurate movement 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 100 Follow up Further evaluation A During the course of
81. o the next screen _ Sound CVC I VF hous Fou sooo o fe fs fu fs wuz z Ww sh ee sh m fao Tow ah ch ohuech ch Jue ch e does not occur in English in this position Therapist Note This articulation screening exercise is designed to evaluate the client s speech for accurate production of 24 consonant and 16 different vowel sounds The client will be presented with a word to produce Click on the Record button in the Practice box and have the client say the word Record over the sample until you are satisfied with the production Speech Visualization will save the production so that you can re play it later to demonstrate progress When the client has finished recording the clinician will need to score the production There are several scoring options You may score the entire production word as Incorrect or you may score the individual speech sounds in the CVC pattern These will be reported as correct or incorrect by position and sound on the results page You may use the Assessment Notes to indicate sound substitutions 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 40 Click Next when you are ready to continue The speech sample can be saved in a file by date and title Phonological Accuracy Screening CVC SOAP Note Rules O The client produced words Their production of the word was incorrect of the time They incorrectly produced the initial conso
82. ocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 42 If you have recorded the client s production then you must score the production before moving on to the next word If you want to skip a word do not record anything and the program will let you proceed to the next word without scoring Click Next when you are ready to continue The speech sample can be saved in a file by date and title Phonological Accuracy Deep Test IMF SOAP Note Rules O The client produced words Their production of the word with the initial consonant was incorrect of the time with the medial consonant of the time and the final consonant was incorrect of the time Clinician Selected Check Boxes A Characteristics also observed were LI Speech was unintelligible Speech characterized by weak articulatory contacts Speech was very difficult to understand Speech in conversation is significantly poorer than in isolation Speech was consistently accurate Speech was intelligible with careful listening Speech was mostly accurate but errors were observed Speech was frequently accurate but noticeably in error Speech was infrequently accurate but occasional accuracy was possible Speech contained multiple sound omissions deletions and or substitutions Speech characterized by vowelization Gestures supplemented speech Tongue protrusion LI Mouth open at rest Speech improved with external prompting Types of Errors LI Initial c
83. of 160 180 WPM are typical of descriptive factual and humorous light reading The client read ___ words correctly out of ____ total words with a rate of Words Correct Per Minute WCPM ___ of the words were produced correctly Norms are available for grades 1 8 At grade a weak reader below the 10th percentile would read approximately __ WPM in the Fall and __ WPM in the Spring An average reader 25th to 75th percentile would read approximately ___ WPM in the Fall and __ WPM in the Spring A good reader above the 90th percentile would read approximately ___ WPM in the Fall and ___ WPM in the Spring Clinician Selected Check Boxes A Characteristics also observed were Rate LI Rate is too fast Too few pauses for thought breaks conveys nervousness Rate is too slow Too many pauses conveys uncertainty Rate is inconsistent Rate does not match content gives inaccurate message Rhythm LI Rhythm is inappropriate Rhythm is jerky Rhythm is patterned and unusual LI Rhythm is awkward with poor phrasing Rhythm is disrupted by excessive delay before responding 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 34 Phrasing Sound syllable word repetitions Single word revisions Dysfluent cluttering like speech not stuttering Word by word reading Accuracy LI Noticeable reading or speech errors due to rapid rate Noticeable slowing of reading or speech due to problems with de
84. on High risk behaviors A Follow up evaluation or screening by a physician for a possible reflux disorder is indicated The following high risk behaviors were reported or observed in the course of treatment LI Singing professionally LI Smoking Drinking large amounts of caffeinated beverages Drinking large amounts of alcoholic beverages Overeating or eating to full satiation Frequently eating spicy foods Eating then lying down Being sedentary or on bedrest Medications not taken with food when indicated Decline in functional reserve failure to thrive 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 95 Risk Assessment Dysphagia Clinical Features to trigger a referral for further evaluation Daniels et al 1997 A 2 6 symptoms indicate a referral for further evaluation is indicated Pulse Oxygen levels may also be used to determine current functioning LI Dysphonia hoarseness Dysarthria speech disorder due to muscle weakness Abnormal Volitional Cough can t or doesn t sound productive Bilateral absence of a gag reflex Person coughs after swallowing Voice changes after swallowing gurgle wet sounding P This client demonstrated two or more symptoms this indicates a need for further evaluation Client will likely need a Modified Barium Swallow MBS study fewer than 2 symptoms and normal Pulse Ox levels No further evaluation is necessary Oral feeding is okay Reassess
85. ond 3 syllables per second pu ku pu ku pu ku pu ku pu ku pu ku tu ku tu ku tu ku tu ku tu ku tu ku pu tu ku pu tu ku pu tu ku Therapist Note Rapid syllable repetition can be used as a sensitive measurement of oralfacial motor impairment In this exercise the client will attempt to produce a maximum repetition rate MRR for selected syllables Make observations concerning the sequencing speed and number of repetitions in addition to the variation between successive syllables A longer syllable duration is often found in dysarthria and syllable sequencing problems are found in apraxia Both qualitative and quantitative observations should be noted SOAP Note Rules O The client used a pacing sequence set to 1 2 and 3 beats per second to practice the repetition of alternating syllable sequences The client produced repetitions of the syllable sequence in____ seconds At 1 syllable per second there were correct productions and incorrect productions ____ At 2 syllables per second there were correct productions ___ and incorrect productions ___ At 3 syllables per second there were correct productions and incorrect productions Clinician Selected Check Boxes A Same as Syllable Stress and Sequencing Assessment Exercise 1 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800
86. onsonant errors LI Medial consonant errors LI Final consonant errors Vowel production errors Evaluation of consonant clusters is indicated 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 43 Assessment Exercise 3 Screening R S L Clusters Other Clusters and R Controlled Vowels These words contain a target sound in the initial medial or final position Say these words paying close attention to the target sound Score the production before moving to the next screen mother nature major hammer owner hanger dozer 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 44 a foe a mow wim et es C S e a salt es a a a C a a e C a a e a S S al 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 45 mt mt C a a a pans pants es a C a e a a C a E eo eo Ca a S e a Therapist Note The R S L screening is designed to evaluate the client s speech for accurate production of R S and L clusters and R Controlled vowels in the initial medial and final positions Some sounds are not produced in some positions in English these have been omitted 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 46 The client will be presented with one word in each of the three Text boxes They may read the model or li
87. ort O The client s performance at ___ seconds for s and ____ seconds for z is less than the average performance of children adults and indicates a possible respiratory insufficiency The S Z ratio was ___ Further evaluation of vital capacity is recommended Scenario 3 If the S Z ratio is between 1 2 and 1 4 O The client s performance for s was _____ seconds and for z was ___ seconds The S Z ratio of ___1s greater than 1 2 1 which indicates possible vocal fold pathology Unequal s and z productions typically indicate a laryngeal problem Follow up evaluation for laryngeal pathology is recommended Scenario 4 If the S Z ratio is greater than 1 4 O The client s performance for s was ____ seconds and for z was ____ seconds The S Z ratio of ___ was greater than 1 4 1 95 of individuals with a ratio higher than 1 4 1 had vocal fold pathology Prater and Swift 1984 Follow up evaluation is recommended A Characteristics observed were LI Normal LI Too Loud LI Too Quiet LI Too Much Fluctuation LI Inappropriate LI Absent Assessment Exercise 2 Sustaining Vowels Take a deep breath As you let it out say the vowel ee for as long as you can Record three trials and choose the longest of the three er ir ur ear Therapist Note The client should record the target vowel sound into each of the three Trial boxes Speech Visualization will then highlight the client s production in blue and display the leng
88. ought till at last they cut down a pole tied the Donkey s feet to it and raised the pole and the Donkey to their shoulders They went along amid the laughter of all who met them till they came to Market Bridge when the Donkey getting one of his feet loose kicked out and caused the Boy to drop his end of the pole In the struggle the Donkey fell over the bridge and his fore feet being tied together he was drowned That will teach you said an old man who had followed them Please all and you will please none Total Words in Passage 309 Bed in Summer R L Stevenson In winter I get up at night And dress by yellow candle light In summer quite the other way I have to go to bed by day I have to go to bed and see The birds still hopping on the tree Or hear the grown up people s feet Still going past me in the street And does it not seem hard to you When all the sky is clear and blue And I should like so much to play To have to go to bed by day Total Words in Passage 88 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 32 The Road Not Taken Robert Frost Two roads diverged in a yellow wood And sorry I could not travel both And be one traveler long I stood And looked down one as far as I could To where it bent in the undergrowth Then took the other as just as fair And having perhaps the better claim Because it was grassy and wanted wear Though as
89. our com Page 15 SOAP Note Rules O The client s breath support and loudness was judged to be Normal The client s breath support or loudness was judged to be normal This indicates that breath support loudness is consistently accurate and rarely inerror ___ normal __ too quiet ___ too loud Good The client s breath support or loudness was judged to be good This indicates that breath support loudness was mostly accurate but there were errors in the sample __ normal ___ too quiet _ too loud Fair The client s breath support or loudness was judged to be fair This indicates that breath support loudness was frequently accurate but noticeably in error _ normal _ too quiet ___ too loud Poor The client s breath support or loudness was judged to be poor This indicates that breath support loudness was infrequently accurate but occasional accuracy was possible ___ normal ___ too quiet _ too loud Absent The client s breath support or loudness was judged to be none This indicates that breath support loudness was inaccurate normal breath support loudness was never heard ___ normal tooquiet _ too loud Clinician Selected Check Boxes A Same as Evaluation Exercise 1 Therapy Exercise 2 Developing Improved Breath Support Improved breath support can be achieved through improved posture and diaphragmatic breathing Sit up in the chair shoulders down head and chin in a relaxed position then speak into
90. ournal of the Acoustical Society of America 11 373 374 Fletcher S G 1972a Contingencies for bioelectronic modification of nasality Journal of Speech and Hearing Disorders 37 329 46 Fletcher S G 1972b Time by count measurement of diadochokinetic syllable rate Journal of Speech and Hearing Research 15 763 67 Fairbanks G 1940 Recent studies of fundamental vocal pitch in speech The Journal of the Acoustical Society of America 11 373 374 Jacobs Joseph in Gibbs J 2002 Aesop s fables The man the boy and the donkey Retrieved from www mythfolklore net aesopica perry noperry Johns D F 1978 Clinical management of neurogenic communicative disorders Boston Little Brown and Co Hasbrouck J amp Tindal G 2005 Oral reading fluency norms a valuable tool for reading teachers The Reading 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 78 Teacher 69 7 636 644 Hirano M 1981 Clinical examination of voice Wien NY Springer Verlag Husband G 1999 What s in Your Music Retrieved from http www tnt audio com Isshiki N 1981 Vocal efficiency index In K N Stevens amp M Hirano Eds Vocal fold physiology 193 207 Tokyo University of Tokyo Press Isshiki N amp Takeuchi Y 1970 Factor analysis of hoarseness Studia Phonologica 5 37 44 Kent R D Kent J F amp Rosenbeck J C 1987 Maximum performance
91. peech sound to more accurately reflect your assessment of the speech Click and drag on an area of speech to highlight it Then use the buttons on the bottom left to mark the sample as Glottal or Breathy Click on Rescore and the percentages reported on the right will update Practice a ne in w uw w in D a un in 5310 Hz 3270 Hz 85 dB _2020 Hz 80 dB _1240 Hz 770 Hz OdB_ 470 Hz 290 Hz 180 Hz 110 Hz 70 Hz 40 Hz gt Breathy X Remove Rescore Record p Play Save Recording Glottal 1 709 6 Breathy 12 69 Sample Time 5 9s Glottal What do the colors mean Blue means highlighting The blue highlight turns to lime green then yellow when you click on the Breathy button To identify an area as Glottal select the area The blue highlight appears when you click on the Glottal button the selected area turns brown When it is deselected it turns red Highlighting over top of an existing glottal production turns the area brown If you highlight a section of speech and mark it as both Glottal and Breathy the area will be dark purple then finally pink when you click anywhere else on the bar The colors seem complicated at first but that is just the way the colors appear when overlapped To sum it up Yellow Breathy Glottal Red Pink Glottal and Breathy Lime green and brown mean you aren t done with the highlighting and need to click on the bar to show the fin
92. pitch range It has two components the upper and lower limits In the upper limit portion of the exercise clients will exhale with an audible sigh to get them to start at their optimal pitch They will then count up the note scale from one to eight The client may add higher notes if they choose Speech Visualization will attempt to find the highest note and use it to determine the upper limit of the client s pitch range Alternately you may select the portion of the sound containing the spoken number eight or the highest tone Speech Visualization will use your selection to calculate the upper limit of the client s pitch range You may choose to include or exclude falsetto The upper limit is displayed next to the Record button If you are satisfied with Speech Visualization s determination you can click Next at this point to continue to the lower limit portion of the exercise If you are not satisfied you can select a portion of sound for Speech Visualization to use to calculate the upper limit You should select the last note and try to limit your selection to the part where the green pitch lines are straight and level If the pitch lines are never straight and level select the whole note Falsetto can be included or excluded at this point Speech Visualization will update the upper limit to reflect your selection When you are satisfied click Next to continue to the lower limit portion of the exercise You must complete Dx2 Fin
93. re the green pitch lines are straight and level If the pitch lines are never straight and level select the whole note Glottal fry can be included or excluded at this point Speech Visualization will update the lower limit to reflect your selection When you are satisfied click Next to continue 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 18 You must complete Dx2 Finding Pitch Range before you can do Dx3 Pitch Range in Context SOAP Note Rules O The client s singing pitch range is from ____ to Hz or to on the musical scale The typical speaking pitch range for a male female aged is to Hz or to i The client s pitch range is typical atypical The client s pitch range is broader than narrower than average Clinician Selected Check Boxes A Same as Pitch and Intonation Assessment Exercise 1 Assessment Exercise 3 Finding Pitch Range in Context Speak or read for at least 10 seconds to determine the pitch range in running speech Therapist Note The client should speak into the microphone in a normal conversational tone for at least 10 seconds Speech Visualization will analyze the client s speech to determine the pitch range they use in conversation When the client has finished speaking click Next Speech Visualization will show a Phonetogram which graphs the client s pitch vs their loudness The Phonetogram is not a waveform which shows volume over time it is
94. rect below the graph Then click Next to perform the stressed portion of the exercise In the stressed portion they should click Record and imitate the model sentence remembering to place stress on the appropriate word When they have finished recording compare their production to the model Score the client s production using the C or J buttons Correct Incorrect below the graph Then click Next to continue If you do not click on the C or I button to score the passage will be scored as correct when the Next button is clicked Some problems to watch for are excessive equal or misplaced stress An additional therapy activity would be to shift emphasis to other words in the sentence This will demonstrate how the meanings and implications of the sentence can shift in conversational speech Help your client identify the unstated message Advanced practice may include using intonation to reflect the following tones of voice fearful joyful humorous assertive sarcastic sincere sad happy angry sensitive content impatient humble and arrogant SOAP Note Rules O The client s imitation of the target utterance was appropriate of the time for normal speech and appropriate of the time when using intonational stress to convey meaning Clinician Selected Check Boxes A Same as Pitch and Intonation Therapy Exercise 1 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 23 Article
95. resseese i Treatment Segu C aono cays ase a cin ce gas da suinsiodys seer ve Bee dev ce oeiec Sis se ga Bande casei EE A E RES 8 Module 1 Breath Support and Loudness iissscceccasistsscassaeticasdarseniasssnassaeidoashabacaplessstaaanaiadsatedeartinesnaues 11 Mo d ule 2 Pitch and Intonation ascienca aei a Ea EE a ewes 17 Mod le VOO a a a a aT tude ea a domes 28 Module 4 Timing Rate and Rhythm eeseseeseeessesssesseeseessrssreesersseessrssrtesesstesseesseeseesseeseressesseresse 31 Module 5 Phonological Accuracy esessessesessseessesesssressessrssressesstsseessesstssresseestsstessteseesrrssteseseesseesse 39 Module 6 Syllable Stress and Sequencing sesssseeseesesesessesesseserssressessresseesresseessesseessesseesseeseessesse 48 Module 7 Vocal Quality and Resonance i22cesstusSesevcssGaninie sek cee eee 57 Check boxes that are available for each session sssseesessssesesessessessseesersseessresseesrssseessessreeseesseesres 70 Desciiptiomof Perins iste cirsgsed hue nett a a a a a Peete tae ae ai teen 73 Referentes ison iina aa in ne a A ats ola a a E aaa Rape eet des Aa aS 77 Voice Careand Treatment raone Ie SY Raat NGaace cael vine A Saath a a ead hades a E aa 80 Vocal Hygiene Exercis Sisnntaninsr ien aa a esas oh Ss ata eS a 82 Vocal Hy siene PRECISE ci reii hari a A R E eytunncteaeste saa pi lacey baat oeaea i eilacey a a 83 History Voice Disorders Intake neck ist 2e522 425 sags svsacsvsaiead neta dass nice
96. rley Aronson and Brown 1975 Chamberlin and Narins 2005 Johns 1978 Spastic dysarthria A The client exhibited the following symptoms consistent with Spastic Dysarthria LI Upper Motor Neuron damage Abnormally excessive nasal speech quality Imprecise articulation behaviors slurring periods of speech unintelligibility Slow labored rate of speech Strained or strangled voice quality Limited vocal pitch Difficulty with loudness range and volume control Overall disruptive speech breathing patterns incoordinated shallow forced or uncontrolled Co occurring weakness and paralysis of all four limbs Widespread involvement of the tongue lip jaw soft palate larynx and respiratory muscles Emotionally labile Swallowing difficulties dysphagia Unilateral Upper Motor Neuron UMN Dysarthria A The client exhibited the following symptoms consistent with Unilateral UMN Dysarthria LI Damage to either the left or right UMN tract Mild to moderate weakness and paralysis of the lower face tongue arm and leg on the side of the body opposite the damaged UMN tract unilateral problem Mild speech production and swallowing difficulties Opposite half of the lips and tongue often compensate Typically normal breathing and inflection Typically normal nasal resonance Aphasia Apraxia Ataxic Dysarthria A The client exhibited the following symptoms consistent with Ataxic Dysarthria Damage to the cerebellum or brain stem Difficulty regulating
97. rotate your head in a circular motion not allowing your head to fall backwards Rotate 5 times clockwise and 5 times counterclockwise This exercise loosens the muscles in the sides and back of your neck 7 Lie on your back sit upright or stand with your back flat against a wall Place your hands on your abdomen Move your abdomen in and out without breathing Localize the movement to your abdomen do not lift your shoulders or chest Repeat 10 15 times You are exercising your diaphragm muscle 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 83 Vocal Hygiene Exercises 8 In one of the positions mentioned above slowly inhale moving your abdomen outward Then slowly exhale allowing your abdomen to move inward again Relax your abdomen on inhalation and contract on exhalation You may also choose to do this exercise while bending over from the sitting or standing position with your arms hanging loosely downward Again do not let your shoulders or chest rise all of the movement should be in your abdomen Repeat 10 15 times 9 Add phonation to the exercise above Say ah ee oh oo and ie with an easy onset during exhalation The goal is to increase the amount of time between breaths during conversational speech This is called breath support 10 Gently massage your jaw muscle at the joint working forward to mid jaw Let your mouth hang open slightly Massage each sid
98. rotrusion Labored breathing Other Observations Tone A The facial tone was Normal Flaccid Mask like Tense Other Observations Lips Protrusion A Lips for a pucker Protrusion was L Symmetrical even Normal Asymmetrical uneven with a weakness on right unilateral Asymmetrical uneven with a weakness on left unilateral Asymmetrical uneven with a bilateral droop Other Observations Lips Retraction A Lips for a smile Retraction was Symmetrical even Normal Asymmetrical uneven with a weakness on right unilateral Asymmetrical uneven with a weakness on left unilateral Asymmetrical uneven with a bilateral droop Other Observations Lips strength A When asked to puff cheeks and hold air the lip strength was L Normal Weak reduced air escaped Other Observations Normal 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 89 Nasal emission A Nasal emission was Normal not present L Abnormal nasal emission present Other Observations Drooling A Drooling was LI Absent Normal L Present Constant Present Intermittent LI Other Observations Oral Peripheral Evaluation Teeth Teeth A The Teeth were LI Normal Missing Edentulous __ teeth present Jumbled spaces misaligned crowded teeth Chewing surfaces were adequate for all food textures Chewing surfaces were inadequate for some food textures
99. rson typically uses for speech Men typically have a lower pitch and women a higher pitch The computer will measure the fundamental frequency of the voice and give a typical range for a male adult teen and child voice as well as a range selection for a female adult teen and child voice The table used to compile the ranges comes from D K Wilson Voice Problems of Children 3 ed Baltimore Williams amp Wilkins 1987 Falsetto includes the upper ranges of the person s normal pitch range Vocal fry or Glottal fry includes the lowest ranges of the person s normal pitch range and sometimes is described as gravelly Optimum pitch range is where the physical features of the vocal tract are most comfortable for vibration It can usually be found by humming uh humm yes and using that tone as the midline for 8 notes Prosody characteristics convey information about intention and meaning We will use the following to describe these speech aspects Segmental aspects refer to articulation of each speech sound precision Suprasegmental aspects refer to all of the aspects of prosody that signal meaning Grammatical prosody can be used to signal whether a word is to be understood as a noun or a verb The stress on a word changes the meaning of the word pre sent or present Pragmatic prosody includes emphatic or contrastive stress that calls attention to new content in the speech utterance You bought the blue dress
100. s l a We saw a play at the theater A single student won the contest 2 an She saw an elephant at the zoo You think I can eat just an apple a day 3 the The cat was on the couch It wasn t just any prince it was the Prince of Monaco Prepositions 4 at Pll meet you at the restaurant You will need to be there at five 5 for Which present did you get for her Did you vote for or against him 6 from It came from New Jersey I can t guess who is it from 7 into She finally got into the Thursday night class It is easy enough to get into a maze 8 of We took care of all the details You did say Of the people and for the people 9 to Would they go to the store I walked fo the store and got a ride home Conjunctions 10 and Bob and John are baseball players Bill Joan and Syndi are on the team ll as She spilled the milk as she got up It is soft as silk 12 but They cleaned up but they didn t want to She finished all but the hard parts 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 24 13 or It doesn t matter wear the red or the green dress You can have candy or cake not both 14 than This stick is longer than that one It was sharper than a knife Auxiliary Verbs 15 am I am going to eat the whole thing I am running a marathon on Saturday 16 are You are needed in the cafeteria Yo
101. sation at home birds chirping night noises sounds j m d b n ng l r vowels Typical outside conversation moderate restaurant noises typical quiet conversation speech is easy to hear in a 55 65 dB low noise environment Noise in a large shop normal conversational speech department store City street slightly animated conversation bus noisy restaurant busy traffic baby crying voice must be raised to hear in a 65 75 dB medium noise environment Noisy office with typing talking over noise in a classroom loud music Niagara Falls dog barking nearby speech is difficult to hear in a 75 85 dB high noise environment Underground railway train passing pneumatic drill talking over the noise at a party Speech is almost impossible to hear in a 85 95 dB very high noise environment Typical rock concert person shouting 3 feet away Prop aircraft taking off jet engine jet skis thunder risk of hearing damage in less than 1 hour of exposure Jet aircraft taking off risk of hearing damage in less than 15 minutes Threshold of pain firecracker air raid siren Therapy Exercise 1 Maintaining Appropriate Volume Speak into the microphone at a normal comfortable loudness level Complete three trials and select a sample for the computer to analyze Therapist Note Same as Breath Support and Loudness Assessment Exercise 3 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuT
102. served 800 777 3166 or www LocuTour com Page 5 Colors for the Sound Level Meter 86 dB Ea Too loud noticeably inappropriate 81 85 Loud but acceptable for a large room or crowd 71 80 Normal acceptable for a small room or typical conversation 65 70 yellow Quiet whispered speech o lt 65 M Too quiet for conversational speech Eare Recording As you are speaking you will see lines appear in the sound recording area The blue line indicates the volume of the speech For some clients the production will not show up as loud or as big as the model This is not necessarily a problem your recording may be loud enough based on what you determine to be the volume goal If you want the appearance of a big blue band for loudness then move the microphone closer Try to establish a consistent microphone to mouth distance so that volume for different sessions can be compared If you are not working on volume as a target then it is acceptable to ignore the blue band Norms for volume are found in the Guide Loudness and pressure levels chart found at the end of Module 1 Speech produced right into the microphone will be measured as being louder than speech produced 3 feet away from the microphone We set the loudness level assuming you are speaking directly into the microphone If the loudness level doesn t seem right readjust the microphone to mouth distance and check you microphone input volume in your computer s control panels s
103. sten to the speech model imitative Click on the Record button in each Practice box and have the client say the word Record over the sample until you are satisfied with the production Speech Visualization will save the production so that you can re play it later to demonstrate progress When the client has finished recording the clinician will need to score each production There are several scoring options You may score the entire production as correct or incorrect or you may score the individual target speech sound in one of the three locations Initial Medial Final These will be reported as correct or incorrect by position and sound on the results page Vowels are not scored in this exercise You may use the Assessment Notes to indicate sound substitutions If you have recorded the client s production then you must score the production before moving on to the next word If you want to skip a word do not record anything and the program will let you proceed to the next word without scoring Click Next when you are ready to continue The speech sample can be saved in a file by date and title Phonological Accuracy Clusters IMF SOAP Note Rules O Same as Phonological Accuracy Assessment Exercise 2 Clinician Selected Check Boxes Same as assessment Exercise 2 A Characteristics also observed were LI Speech was unintelligible LI Speech characterized by weak articulatory contacts LI Speech was very difficult to understand LI Speech
104. t difference between speech rate and articulatory rate may indicate other communication disorders e g fluency disorder word retrieval disorder reading disorder etc Clinician Selected Check Boxes A Same as Voicing Assessment Exercise 1 Therapy Exercise 1 Endurance for Reading Speech This task can be either a reading or speech endurance task If you are doing this task as a reading endurance task then read the paragraph aloud using your typical reading rate If this is a speech endurance task talk at a normal rate Therapist Note Choose a reading passage from one of the selections in Assessment Exercise or from text that you provide If you provide the text or if this is a speech endurance task you will need to enter the number of words in the sample in order for Speech Visualization to calculate the rate SOAP Note Rules O Same as Voicing Assessment Exercise 1 Clinician Selected Check Boxes A Same as Voicing Assessment Exercise 1 Guide Reading Rate adults Words per Minute WPM Type of Text 120 140 Usually considered excessively slow for speech but might be used to provide emphasis to complex profound or sad material 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 36 Guide Reading Rate children from Hasbrouck amp Tindal 2005 Grade Weak Readers 10 Average Readers Good Readers 90 Words Correct per WCPM 50 Fall Spring Minute WCPM
105. tch One Target Word in Sentence Tx 5 Pitch Range Practice Speech in Context V Module 3 Voicing 5 Dx 1 Evaluation of Glottal Stops and Breathiness E Tx 1 Receptive and Negative Practice Glottal Stops E Tx 2 Voicing Practice Sounds Phrases and Sentences Y Module 4 Timing Rate and Rhythm 1 Dx 1 Determining Typical Reading Rate E Dx 2 Determining 19 Typical Speech Rate 5 Tx 1 Endurance for Reading Speech Y Module 5 Phonological Accuracy Dx 1 Screening CVC 5 Dx 2 Deep Test IMF Y GB Dx 3 Screening R S L Clusters Other Clusters and R Controlled Vowels R Clusters Select All lt Select All Remove All a Move Up W Move Down q Back Next p C Cancel LI To include an exercise in the treatment plan double click it It will appear in the list on the right side If you double click a folder Speech Visualization will add all the exercises in that folder to your treatment plan To remove an exercise from the treatment plan select it from the list on the right side and double click it LI To change the order of the exercises select an exercise and then click the Move Up or Move Down buttons Use Select Exercises screens to select which areas to target for today s session Double click on an exercise to add it to the panel on the right Today s Treatment Plan LI When you are finished choosing exercises click Next If you have chosen any exercises that have multipl
106. tch and Intonation Timing Rate and Rhythm Breath Support and Loudness Syllable Stress and Sequencing Vocal Quality and Resonance Phonological Accuracy O Voicing Down Syndrome Phonological Accuracy Syllable Stress and Sequencing Pitch and Intonation Breath Support and Loudness Timing Rate and Rhythm LI Vocal Quality and Resonance Voicing Age Related Voice changes L Breath Support and Loudness LI Pitch and Intonation LI Vocal Quality and Resonance LI Voicing Syllable Stress and Sequencing _ Phonological Accuracy Timing Rate and Rhythm 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 10 Module 1 Breath Support and Loudness Assessment Exercise 1 S Z Ratio Task Producing s Take a deep breath As you let it out say the sound s for as long as you can Children should be able to sustain the sound for 10 seconds adults for 20 25 seconds Record three trials and choose the longest of the three Producing 7 Take a deep breath As you let it out say the sound z for as long as you can Children should be able to sustain the sound for 10 seconds adults for 20 25 seconds Record three trials and choose the longest of the three Therapist Notenasa The client should record an s or a z sound into each of the three Trial boxes Speech Visualization will then highlight the client s production in blue and display the length in seconds of the prod
107. te rapidly Individuals who cannot sustain p t k and switch to b d g likely have an apraxic or dysarthric disorder Norms are not available for b d g therefore the reference norms for p t k are provided as a guideline Normative data on MMR converted from Fletcher 1972b by Kent Kent and Rosenbek 1987 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 50 Mex a sa Fletcher 1972b Adult converted from Kent Kent and Rosenbek 1987 Data included on the O Note is from this table Clinician Selected Check Boxes A LI Switched from p t or k to voiced b d or g indicating difficulty with control of oral productions LI Production started strong but preciseness deteriorated and production became slurred LI Unable to sustain for 20 15 or 10 repetitions as required LI Rate was slow and sequencing was inaccurate LI Rate was slow but sequencing was accurate LI Rate was fast and sequencing was inaccurate LI Rate was inconsistent LI Accuracy was inconsistent 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 51 Therapy Exercise 1 Alternating Syllable Practice This is a practice exercise in order to learn how to accurately sequence syllables Clap your hands and at the same time say one syllable per second Listen to the model and imitate the production for about 20 seconds 1 syllable per second 2 syllables per sec
108. ted from data obtained by Singh and Frank 1972 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 48 Module 6 Syllable Stress and Sequencing Assessment Exercise 1 Syllable Sequencing Diadochokinesis Part I p t k Y series 1 syllable repetition Make 20 accurate repetitions of the following syllables as fast as you can Say pu pu pu pu pu Say tu tu tu tu tu Say ku ku ku ku ku Part II p t k series 2 syllable repetition Make 15 accurate sequences as fast as you can For example putu is one sequence Say putu putu putu Say tuku tuku tuku Part II p t k series 3 syllable repetition Make 10 accurate sequences as fast as you can For example putuku is one sequence Say putuku putuku putuku putuku Alternate Part I b d g series 1 syllable repetition Make 20 accurate repetitions of the following syllables as fast as you can Say bu bu bu bu bu Say du du du du du Say gu gu gu gu gu Alternate Part II b d g series 2 syllable repetition Make 15 accurate sequences as fast as you can For example budu is one sequence Say budu budu budu Say dugu dugu dugu Alternate Part III b d g series 3 syllable repetition Make 10 accurate sequences as fast as you can For example budugu is one sequence Sa
109. tests of speech production Journal of Speech and Hearing Disorders 52 367 387 King R G amp DiMichael E M 1978 Articulation and voice Improving oral communication New York Macmillan Publishing Co Inc Klingholz F amp Martin F 1985 Quantitative spectral evaluation of shimmer and jitter Journal of Speech and Hearing Research 28 169 174 Lindh J 2006 Preliminary descriptive F0 statistics for young male speakers Working Papers 52 89 92 Retrieved from www ling lu se conference fonetik2006 pdf lindh_ 2 fon06 pdf Linville S E 2004 The Aging Voice The ASHA Leader 12 21 Mason R M amp Grandstaff H L 1971 Evaluating the velopharyngeal mechanism in hypernasal speakers Language Speech and Hearing Services in Schools 1 53 McAfee A M 1998 Assessment in speech language pathology CD ROM San Diego Singular Publishing Group Inc Odell K H amp Shriberg L D 2001 Prosody voice characteristics of children and adults with apraxia of speech Clinical Linguistics and Phonetics 15 275 307 Ohno S Masamichi F amp Fujisaki H 1996 Quantitative analysis of the local speech rate and its application to speech synthesis Proceedings of ICSLP 96 4 2254 2257 Patel R 2002 How speakers with and without speech impairment mark the question statement contrast Proceedings of the International Conference on Spoken Language Processing 570 574 Pindzola R H Jenkins
110. th in seconds of the production next to the Record button The longest continuous sample in the three trials will be automatically selected by the program as the best recording If Speech Visualization highlighted sound you don t want to include or didn t highlight sound you do want to include you will need to select the desired portion of the client s production yourself Highlight the preferred selection by clicking and dragging the cursor over the speech sample to be analyzed 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 12 Once you are satisfied that the client s production is accurately highlighted in each of the three trials pick the trial you want Speech Visualization to analyze and save Usually the longest trial is the optimal trial if quality is maintained in the production Pick a trial by selecting the radio button to the left of the sound graph When you are satisfied with the highlighting and the selection of the sample click Next to continue SOAP Note Rules Length for each vowel sound O The client produced ___ for _____ seconds Maximum Phonation Time MPT this was was not in the normal range ____ seconds or longer and is consistent inconsistent with other child adult speakers The decibel range was from dB to dB __ of the sample was in the too quiet range _ of the sample was in the too loud range and __ of the sample was at an appropriate speaking volume
111. the microphone at a normal comfortable loudness level Complete three trials and select a sample for the computer to analyze Therapist Note Same as Breath Support and Loudness Assessment Exercise 3 SOAP Note Rules O Same as Breath Support and Loudness Therapy Exercise 1 Clinician Selected Check Boxes A Same as Breath Support and Loudness Evaluation Exercise 1 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 16 Module 2 Pitch and Intonation Assessment Exercise 1 Finding Optimal Pitch Take in a breath yawn then exhale with an audible sigh or ah sound Therapist Note Speech Visualization will determine the client s optimal pitch The client should yawn with an audible ah sound into the microphone After they finish recording Speech Visualization will make an initial guess about the optimal pitch If you are satisfied with this guess you can click Next to continue The initial guess however is not likely to be very accurate This is because Speech Visualization will use the entire sound for calculating the optimal pitch including both the breathy and voiced parts of the client s yawn To more accurately determine the optimal pitch you should highlight the voiced part or the ah part of the client s production while leaving the breathy parts unselected Speech Visualization will then use your selection to make a more accurate guess about the optimal pitch
112. the models Score the client s production using the C or J buttons Correct Incorrect below the graph If nothing is selected it will be scored as correct when the Next button is clicked When you have finished scoring the client s productions click Next to continue SOAP Note Rules O The client s imitation of intonation for the combined sample was correct and _ __ incorrect Clinician Selected Check Boxes A Same as Pitch and Intonation Assessment Exercise 1 Therapy Exercise 2 Intonation Drills Phrases Sentences Say the following phrases or sentences with three different intonations Monotone Rising and Falling 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 21 Monotone Rising Falling Incorrect production Correct production Correct production to convey meaning to convey meaning Therapist Note Same as Pitch and Intonation Therapy Exercise 1 SOAP Note Rules O Same as Pitch and Intonation Therapy Exercise 1 Clinician Selected Check Boxes A Same as Pitch and Intonation Assessment Exercise 1 Therapy Exercise 3 Intonation Drills Sentences Say the following sentences with four different intonations Falling Rising Mixed and Sarcastic Falling intonation Rising intonation Mixed intonation Sarcastic intonation I just don t Will you be at the party I m not so sure I m sorry did I offend understand about that you Ill get the pap
113. the top Open the speech recording program on your computer On most Windows machines it is found in Programs Accessories Entertainment Sound Recorder Record a sound and watch the line bounce around If no sound is recorded then open the Sound Control Panel and select a different Sound Recording device and repeat the above steps Additional sound issues are discussed at www learningfundamentals com support windows php Sound To check the input level on Macs open the Sound Control Panel and select the Input tab and slide the level button all the way to the right Talk into the microphone and you will see the level meter bounce around If it doesn t bounce check that the microphone is connected to the right port then pick a different input source Speech Visualization can usually find your microphone but sometimes it will pick an input device that is not available You will need to select a different microphone in the Microphone Setup Wizard found in the Tools menu T3 The tables in the documents are garbled Client Manager saves the documents in Rich Text Format rtf and opens them in your default program for handling RTF files Some older word processing programs do not handle RTF files well Change your default program to a more modern word processor and they will display fine If you do not have one installed on your computer you can download OpenOffice org a free and open office suite at www openoffice org Macintosh users might prefer NeoOf
114. the first screen play the models for the client and allow them to listen to the three different productions When they are finished listening click Next to proceed to the practice portion of the exercise On the next page the client should press Record and practice saying the word correctly As in previous voicing exercises when the client has finished recording Speech Visualization will analyze the client s production for glottal attacks and breathiness Glottal attacks will be highlighted in red and breathiness will be highlighted in yellow Sound that is both glottal and breathy will be highlighted in pink Some clinicians may elect to teach negative practice This process of practicing wrong intentionally is indicated when the client needs to compare and contrast the different feel of the productions Negative practice is not indicated when it will cause further damage to the vocal folds The ultimate goal is to gain control over the vocal mechanism and produce speech that does not cause physiological damage and is functional Check and review Speech Visualization s guesses If you see an area marked that shouldn t be select it by highlighting it then click Remove If you want to mark an area as a glottal attack or as breathiness select the area and click the Glottal or Breathy button After the appropriate ranges of sound are highlighted Speech Visualization will display the overall glottal and breathy percentages to the right of
115. the voice evaluation other possible communication problems were observed Further evaluation is indicated in the following areas Language Disorders Language Disorders Expressive LI Syntax L Morphology Semantics Pragmatics Written Language Disorders Receptive LI Auditory LI Written Gestures Non verbal language Speech Disorders Speech Disorders LI Phonology Articulation Intelligibility Voice Disorders LI Voice Disorders Dysfluency LI Dysfluency LI Cluttering Sensory Motor Sensory Motor Hearing Vision Motor Smell Taste 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 101 Troubleshooting T1 The recording area is too small to see the sound and can t select portions of it Speech Visualization requires a minimum monitor resolution of 1024x768 to fit all of the sounds on the screen If you have a larger monitor you can drag the bottom right hand corner to make the window larger T2 Nothing happens when click on the record button First make sure that your microphone is plugged into the correct port on your computer Then make sure that if your microphone has volume slider that it is at the maximum level Then check the input level for the microphone To check the input level on Windows machines right click on the speaker icon at the bottom right side of the screen and choose the Levels option Slide the level for Microphone and Line In to
116. thing movements of the tongue Color and Texture Normal color and texture Coated Grooved White Red L Ulcerated Pierced Bifurcated 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 92 Tongue A The client s Tongue is Healthy pink moist LI is Diseased coated blistered cracked ridged LI is often protruding with open mouth breathing LI is protruding because of enlarged Adenoids LI Other Observations Lingual Frenulum the tissue that attaches the tongue to the floor of the mouth LI Normal frenulum L Short frenulum Tongue cannot protrude past lips Surgical history of frenulum _ Bifurcated frenulum A Movement of the Tongue Vertical up down indicated LI Normal range movement and speed Cannot move tongue tip up Cannot move tongue tip down Can move but groping observed Limited range Limited speed A Movement of the Tongue Horizontal right left indicated LI Normal range movement and speed Cannot move tongue tip right Cannot move tongue tip left Can move but groping observed Limited range Limited speed A Movement of the Tongue Protrusion Retraction in out indicated LI Normal range movement and speed Cannot move tongue tip out Cannot move tongue tip in Can move but groping observed Limited range Limited speed Limited strength Bifurcates on protrusion A Other Observations of the tongue LI Insuf
117. tions Modify phonation voice onset and voicing LI Modify resonance Modify volume Modify articulation Modify syllable stress and sequencing Modify rate Modify suprasegmentals prosody rhythm and intonation Provide alternative modes of communication LI Establish and reinforce a maintenance plan Provide follow up care and recommendations to necessary professionals Determine current level of functioning at discharge Assess for communication satisfaction 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 72 Guide Functional Uses of Metronome Pacing Metronome pacing is a timing tool that can help the speaker either speed up or slow down their speech to produce each word in time with the beat Metronome Pacing Beats 10 600 beats per minute bpm 60 bpm default children speak at approximately 240 360 syllables per min read at approximately 60 180 WPM teens speak at approximately 140 200 WPM read at approximately 140 180 WPM adults speak at approximately 174 WPM read aloud at approximately 140 180 WPM read at approximately 200 350 WPM speed reading and skimming 700 1000 WPM books on tape read at approximately 150 175 WPM auctioneer 250 WPM rap fastest rap 723 syllables in 51 27 seconds 14 1 syllables per second by Ricky Brown 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 73 Description of Terms
118. tive and objective values to consider when determining what is normal or deviant in vocal quality The physical structure culture and projections of emotion attitude and mood can all subtly and overtly change the vocal quality 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 59 This is a tool to use to allow you and your client to make those judgments The tasks suggested are typical activities found in Voice textbooks SOAP Note Rules O The client produced the letter P Their unpinched production of the sound had nasal emission ____ of the time Nasal Total Unpinched and their pinched production of the sound had nasal emission __ of the time Nasal Total Pinched There should not be a difference between the pinched and unpinched productions If there is there may be velopharyngeal incompetence A Same as Syllable Stress and Sequencing Assessment Exercise 1 Assessment Exercise 2 Pressure Consonants Say each word at least once It is okay to alternate between a pinched nose closed production and an open nose production Click on the Z incorrect counter for each nasal emission then click on the C correct counter to indicate no nasal emission There should not be a difference between the pinched and unpinched productions If there is there may be velopharyngeal incompetence bit bet bat bat Bert Bart Therapist Note These exercises will allow you to evaluate the
119. tone and very slow movement Dystonia involuntary excessive and uncontrollable quick jerky slow twisting or trembling limb and speech musculature behaviors Articulation is inconsistent and imprecise l Voice is hoarse harsh in quality Rhythm of speech is flat and irregular Breathing patterns are sudden forced and shallow Speech intelligibility is significantly reduced Swallowing difficulties can be a significant problem Flaccid dysarthria A The client exhibited the following symptoms consistent with Flaccid Dysarthria L Lower Motor Neuron damage to nerves that emerge from the brain stem cranial or spinal cord and travel directly to muscles that are involved in speech production Cranial nerves V VII X and XII may be involved LI Trigeminal V Sensation to forehead cheek and jaw mandible chewing Facial VII Eyes mouth lips cheeks Vagus X swallowing phonation uvula soft palate Hypoglossal XII tongue protrusion lateralization Nerves to diaphragm and thoracic spinal nerves that stimulate the chest and abdominal wall muscle may be involved Paralysis Weakness LI Reduced speed of movement LI Depressed tactile feedback LI Limited reflex behaviors Atrophy or shrinkage of muscle tissue 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 99 Fasciculations or twitch like behaviors Tongue fasciculations at rest This pathologic feature is an important differe
120. u are going to eat your broccoli 17 can I can see a bird in the tree Elephants can lift logs 18 could You could cut the rose stems on a diagonal You could walk to school 19 do I do like to see pictures of the ruins I do wash the dishes 20 does It does look like rain It does seem odd that they are still not home 21 had I had made a sandwich but forgot to bring it I had gone to the dentist instead of lunch 22 has He has purchased a new computer He has obtained all of the information he needs 23 have They have scheduled a picnic for Saturday You have to go to the parade 24 must I must remember to get mustard for the lunches I must be forgetting something 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 25 25 should She should walk home from school She should finish her homework 26 was I was working on the car I was eating when you interrupted 27 were We were ordering the pizza We were going to put mushrooms on it 28 will I will be there by 3 00 I will arrive on time 29 would You would eat it all I would like fries with that Linking Verbs 30 am I am not feeling well this morning I ama student 31 was I was sleepy this morning The stew was delicious 32 were They were sure that it would be delivered They were late every time last month Pronouns 33 he I couldn t believe he gave
121. uction next to the Record button The longest continuous sample in the three trials will be automatically selected by the program as the best recording If Speech Visualization highlighted sound you don t want to include or didn t highlight sound you do want to include you will need to select the desired portion of the client s production yourself Highlight the preferred selection by clicking and dragging the cursor over the speech sample to be analyzed Once you are satisfied that the client s production is accurately highlighted in each of the three trials pick the trial you want Speech Visualization to analyze and save Usually the longest trial is the optimal trial if quality is maintained during the production Pick a trial by selecting the radio button to the left of the sound graph Click Next to continue SOAP Note Rules If below average This reduced length may indicate further evaluation for pathology or reduced breath support Treatment is recommended to lengthen vowel production O s z ratio Scenario 1 If the s and z sounds are long enough and in an appropriate ratio O The client s performance for s was ____ seconds and for z was ___ seconds The s z ratio was ___ This indicates normal respiratory ability and the absence of vocal fold pathology 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 11 Scenario 2 If either the s or the z was too sh
122. variation between successive syllables A longer syllable duration is often found in dysarthria and syllable sequencing problems are found in apraxia Both qualitative and quantitative observations should be noted Use the Assessment Notes to document your observations SOAP Note Rules O The client read a passage that required the rapid alternating of speech sounds in context The production for that passage was ___ accurate C Total 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 55 Clinician Selected Check Boxes A Rate _ Rate is too fast AND affects overall stress or sequencing LI Rate is too slow AND affects overall stress or sequencing LI Rate is inconsistent AND affects overall stress or sequencing Rhythm LI Rhythm is inappropriate LI Rhythm is jerky LI Rhythm is patterned and unusual LI Rhythm is awkward with poor phrasing LI Rhythm is disrupted by excessive delay before responding Phrasing LI Sound syllable word repetitions LI Single word revisions Dysfluent cluttering like speech not stuttering LI Word by word reading Accuracy LI Noticeable syllable stress errors due to rapid rate Noticeable syllable sequencing errors due to rapid rate Noticeable slowing of reading or speech due to problems with decoding Noticeable omission of punctuation and appropriate phrasing Accurate reading due to slowed reading rate Stuttering like Dysfluencies Be aware that sy
123. w falls upon the green of the first the result is to give a bow with an abnormally wide yellow band since red and green light when mixed form yellow This is a very common type of bow one showing mainly red and yellow with little or no green or blue Total Words in Passage 330 The Grandfather Passage Fairbanks You wished to know all about my grandfather Well he is nearly ninety three years old he dresses himself in an old black frock coat usually minus several buttons yet he still thinks as swiftly as ever A long flowing beard clings to his chin giving those who observe him a pronounced feeling of the utmost respect When he speaks his voice is just a bit cracked and quivers a trifle Twice each day he plays skillfully and with zest upon our small organ Except in the winter when the snow or ice prevents he slowly takes a short walk in the open air each day We have often urged him to walk more and smoke less but he always answers Banana oil Grandfather likes to be modern in his language Total Words in Passage 131 Aesop s Fables The North Wind and the Sun University of Aberdeen The North Wind and the Sun were disputing which was the stronger when a traveler came along wrapped in a warm cloak They agreed that the one who first succeeded in making the traveler take his cloak off should be considered stronger than the other Then the North Wind blew as hard as he could but the more he blew the more closely did the
124. w quiet is based on the situation age gender and culture of the speaker and listener Suprasegmental information features can be conveyed by altering the loudness of the speech in appropriate places Speech that has no vocal fold vibration is called Aphonic it is whispered speech Speech that is excessively loud is perceived as offensive Modulating the loudness based on the intention to be conveyed is an important aspect of speech communication A whisper conveys a different message than a shout 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 77 References Andrews M L amp Summers A C 1988 Voice Therapy for Adolescents San Diego College Hill Publications ASHA Special Interest Division 3 Voice and Voice Disorders 2006 Consensus Auditory Perceptual Evaluation of Voice CAPE V Retrieved from http ww ASHA org Bailey J M 2006 Comprehensive dysphagia management Inservice at Metropolitan State Hospital CA Birch H G 1956 Experimental investigations in expressive aphasia New York State Journal of Medicine 56 3849 Boone D R 1977 The Voice and Voice Therapy 2 Edition Englewood Cliffs Prentice Hall Boersma P 1993 Accurate short term analysis of the fundamental frequency and the harmonics to noise ratio of a sampled sound Proceedings of the Institute of Phonetic Sciences 17 97 110 Bradley D 2006 The Voice Problem Website Retrieve
125. ween the pinched and unpinched productions If there is there may be velopharyngeal incompetence SOAP Note Rules O The client produced pinched unpinched word pairs Their unpinched production of the first syllable had nasal emission of the time and their production of the second syllable had nasal emission of the time Their pinched production of the first syllable had nasal emission of the time and their production of the second syllable had nasal emission of the time There should not be a difference between the pinched and unpinched productions If there is there may be velopharyngeal incompetence 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 58 Assessment Table for Vocal Quality and Resonance Exercises Consistently accurate rarely in error lt 10 5 Mostly accurate but some assimilation nasality heard in lt 15 4 Frequently accurate but noticeable nasality 16 25 3 Infrequently accurate nasality affects communication 26 80 2 Absent Inaccurate accurate vocal quality or resonance was not observed 1 gt 80 nasal emission Clinician Selected Check Boxes A Characteristics also observed were LI Breathy LI Rough LI Strained LI Break shift tremulous LI Register Break LI Diplophonia LI Articulatory errors LI Glottal Attack LI Phrasing errors LI Poor breath support LI Poor posture LI Incorrect phrasing LI High rate of speech errors LI Production
126. with any change in clinical status e g new stroke coughing episode refusal of foods Dysphagia Triggers Bailey 2006 A Follow up evaluation or screening for a possible swallowing disorder is indicated The following a triggers were reported or observed in the course of treatment Coughing w signs of struggle Wheezing Wet vocal quality or respirations LI Excessive drooling Pocketing of food in the mouth LI Sudden change of color around the lips and face LI Fever 24 48 hours post suspected incident LI Refusal of foods or liquids Watering eyes LI Gagging Facial grimacing LI Smell of formula on breath Increased residuals Dysphagia Risk Levels Bailey 2006 A Follow up evaluation or screening for a possible swallowing disorder is indicated The following dysphagia risks were reported or observed in the course of treatment Level 1 Patient enterally fed Patient with a risk of aspiration as determined by MBS result greater than 3 on eight point aspiration risk scale Patient with a history of aspiration pneumonia within the past 2 years Patient with Asthma Level 2 Patient determined to be a high choking risk by the IDT Interdisciplinary Dysphagia Team behaviors etc Patient with pharyngeal and esophageal phase dysphagia Patient with a history of aspiration pneumonia in the past 3 5 years 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 96 Level 3 LI
127. y budugu budugu budugu budugu Therapist Note Rapid syllable repetition can be used as a sensitive measurement of oralfacial motor impairment In this exercise the client will attempt to produce a maximum repetition rate MRR for selected syllables Make observations concerning the sequencing speed and number of repetitions in addition to the variation between successive syllables A longer syllable duration is often found in dysarthria and syllable sequencing problems are found in apraxia Both qualitative and quantitative observations should be noted Use the Assessment Notes to document dysarthric features of slowness etc and apraxic features such as unsequenced or perseverative syllable production Alternate Some individuals may not be able to produce p t k but can produce b d g Norms are not available for b d g but the table for p t k may be useful for comparison 2007 2010 LocuTour Multimedia Inc All Rights Reserved 800 777 3166 or www LocuTour com Page 49 SOAP Note Rules O The client produced the syllable sequence in___ seconds There were correct productions and incorrect productions ____ For a child of age this was S D above below the mean of which places them in the average low average impaired range The average adult takes seconds for this sequence The measurement of maximum speech rate is correlated to the integrity of the physical system motor control and the ability to articula
128. you have room on your hard drive you may choose to save all of the speech samples for this session by checking the Save all recordings automatically box above 48 Next Cancel selected click on the Calibrate button and record your voice If you see the level meter move and a wiggly blue line then you have a microphone selected The larger the blue line the better the volume This example is a little too quiet Silence Calibration 1 Make sure you are using the microphone you will normally use p 2 Make sure you are in the room you plan to use for therapy i 3 Set your microphone volume using your computer s volume control 4 Press Record and talk into the microphone The blue line should vary with the loudness of your speech a If it doesn t pick a different microphone on the previous page Calibration Ignore sound quieter than 67 04 B dB 4 Back Next gt Finish When you are sure you have the correct microphone and volume settings click the Record button and make no noise for 10 seconds The computer will ignore sound below the ambient room noise The ambient room noise level should be between 15 and 40dB If it is louder than that the computer may not be able to distinguish vocalizations from room noise LI When the computer has finished recording click the Next button LI Click the Finish button and you will return to the Select Microphone screen If you want to save all the recordings for t

Speech Visualization - Learning Fundamentals

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