Phonologically based assessment and intervention in Spastic Cerebral Palsy: A case analysis

PHONOLOGICALLY BASED ASSESSMENT AND INTERVENTION IN SPASTIC CEREBRAL PALSY: A CASE ANALYSIS MICHAEL A. CRARY (PHD) Speech Pathology and Audiology Southern Illinois University, Carbondale IL 62901 and SUZANNE COMEAU Central Michigan University Mt. Pleasant, Michigan SUMMARY The articulation errors of one adult subject demonstrating a spastic variety of congenital cerebral palsy were evaluated via a phonological process analysis. This analysis indicated that a stopping process (replacement of fricatives with homorganic stops) was the most detrimental to the subject's, intelligibility. Subsequent to this analysis a phonemic contrasting programme was initiated toward the goal of minimizing the influence of the stopping process. Results of spontaneous speech sample analyses indicated that this approach was successful in increasing the percentage of correctly produced fricative patterns. Success in this case suggests the applicability of a linguistically based intervention approach in structural/functional disturbances of speech articulation. Reproduced by Sabinet Gateway under licence granted by the Publisher (dated 2012) OPSOMMING Die artikulasiefoute van 'n volwassene proefpersoon met 'n verskeidenheid spastiese simptome van kongenitale serebrale verlamming, is met behulp van 'n fohologiese proses-analise geevalueer. Die analise het aangetoon dat 'n afsluitingsproses (vervanging van frikatiewe met homorganiese afsluitingsklanke) die proefpersoon se spraakverstaanbaarheid, hoofsaaklik bei'nvloed het. 'n Fonemiese kontrasprogram is hieropvolgend gei'nisieer met die doel om die invloed van die afsluitingsproses te verminder. Die resultate van 'n spontane spraakmonsteranalise het aangedui dat hierdie benadering suksesvol was wat betref die verhoging van korrek geproduseerde frikatidfpatrone. Die sukses behaal suggereer die toepasbaarheid van 'n linguisties gebaseerde benadering by strukturele funksionele artikulasieafwykings. Assessment and intervention of articulatory disorders has traditionally focused on individual sound errors that detract from a client's intelligibility. This approach has been employed commonly for both functional and organic disorders of speech articulation.' Though this approach has been successful to some degree, it often fails to bring about clinically significant improvement in those individuals demonstrating multiple articulation errors.' The past decade has yielded an emphasis on the identification of "patterns of errors" in those cases; where multiple sound errors are observed. A recent development related to this pattern approach of assessment is the identification of general phonological processes in the The South African Journal of Communication Disorders, Vol. 28, 1981 Phonology and Cerebral Palsy 31 defective speech pattern. A phonological process is considered to be a type of "mental operation" which simplifies a production by removing certain difficult properties from that production (Oiler 6 ; Stampe 8 ). In his Dissertation on Natural Phonology, David Stampe 8 points out that although a phonological substitution is a mental operation, it is clearly motivated by the physical character of speech — its neurophysiological, morphological, mechanical, temporal, and acoustic properties (p. 6). Given this description, it is surprising that relatively little attention has been focused on the identification and elimination of phonological processes in organically based articulation disorders. Ingram 5 reviews literature which identified error patterns in the speech of hard-ofhearing, cleft palate, and mentally retarded subjects. Paskowitz and Bond 7 have also used the phonological process approach to identify error patterns in the speech of hearing impaired children. Crary and Hunt 3 (in preparation) have demonstrated the clinical effectiveness of a pattern approach in the identification and subsequent elimination of phonological processes in the speech of one child with a repaired palatal cleft. In a recent didactic article, Crary and Fokes 2 have argued that this approach may be clinically efficient in the identification and elimination of defective articulatory patterns in the speech of neurologically impaired adults. Reproduced by Sabinet Gateway under licence granted by the Publisher (dated 2012) The present study reflects an attempt to: (1) identify phonological processes in the speech of a neurologically impaired adult, (2) quantify the influence of those processes on intelligibility, and (3) reduce the influence of the processes determined to be the most detrimental to perceived intelligibility. METHODOLOGY SUBJECT: The subject was a twenty-five-year-old female with congenital cerebral palsy of the spastic variety. She was enrolled in a public school special class and received one hour of speech therapy per week. Her therapist judged her to be "fairly intelligible" with multiple sound errors evident in her speech pattern. Therapy for the preceding eight months had focused on facilitating correct fricative production at the sound level. Although the subject could produce some fricatives in isolation, there was no reported or observed carryover to the syllable or word level. ASSESSMENT: PROCESS IDENTIFICATION In an attempt to identify phonological processes in the speech pattern of our subject two procedures were employed: (1) the Phonological Process Analysis (Weiner 9 ), and (2) analysis of a spontaneous speech sample using procedures outlined by Crary. 1 Table I presents the results of Weiner's analysis procedure. It can be seen that cluster reduction and stopping were the "strongest" (i.e., most frequent) processes, occurring in 100% and 88% of the test items Die Suid-Afrikaanse Tydskrif vir Kommunikasieafwy kings, Vol. 28, 1981 Μ. Crary & S. Comeau 32 respectively. Cluster reduction was also observed in 75% of the applicable non-test items, while stopping was observed in 89% of the applicable non-test items. In addition, the stopping process was observed in 92% of those clusters involving fricatives. Other processes noted include deletion of final consonants and prevocalic voicing. 9 TABLE I: Results of Phonological Process Analysis (Weiner ) Process % Occurrence in Test Items % Occurrence in Non-Test Items Deletion Final Consonants Cluster Reduction Prevocalic Voicing Stopping 25% (4/16) 100% (28/28) 38% (6/16) 88% (14/16) 39% 75% 27% 89% Reproduced by Sabinet Gateway under licence granted by the Publisher (dated 2012) Table II presents the results of the spontaneous speech analysis. To comprehend these data a brief discussion of the analysis procedures is required. The columm marked "RS" indicates the "Relative Strength" of each process. This is determined by dividing the number of actual occurrences of a process by the number of potential occurrences. " R A " indicates "Relative Appearance" of those phonological patterns simplified by processes. This is determined by dividing the potential occurrence of eac (...truncated)