1. drg. H. Rinaldi, BU, MS, SP. KGA/M10
DEDICATED FOR MOLAR PSPDG UMY 2012
LOGOPEDI 2
COMMUNICATION DISORDERS
o Oral motor and feeding problems
o Articulation
o Language
o Voice
o Fluency
ORAL MOTOR AND FEEDING PROBLEMS
o The problems (earliest)  speech path
o Not successful for feeding
Behaviour
Neuromotor factors
Prematurity
Cleft lip and palate
Long term non oral feeding
Movement patterns for sucking, swallowing
Feeding
o Early speech sound development

2. drg. H. Rinaldi, BU, MS, SP. KGA/M10
DEDICATED FOR MOLAR PSPDG UMY 2012
GANGGUAN KOMUNIKASI
o Gangguan oral motorik dan menelan
o Artikulasi
o Bahasa
o Suara
o Kelancaran/kefasihan
GANGGUAN ORAL MOTORIK DAN MENELAN
o Gangguan (awal)  kesalahan bicara
o Sulit menelan
Kebiasaan
Faktor neuromotor
Kelahiran prematur
Labiopalatoschisis
Makan tidak melalui mulut dalam jangka waktu lama
Pola pergerakan menghisap, menelan
Pemberian makanan/konsumsi
o Perkembangan bicara sejak dini

3. drg. H. Rinaldi, BU, MS, SP. KGA/M10
DEDICATED FOR MOLAR PSPDG UMY 2012
ARTICULATION
o Refers to the production of speech sounds
Modification of the breath stream
Various valves along the vocal tract
Lips
Tongue
Teeth and palate
o Problems
Fairly mild distortion of sounds (cadel/celat)
Still easy to understand (parah)
ERRORS CLASSIFICATION
o Speech Sound Omissions (kelainan)
‘cu’ for ‘cup’
‘te-y’ for ‘teddy’
o Substitutions of Sounds (penggantian)
‘wed’ for ‘red’
‘tun’ for ‘sun’
o Distorsions
Lateral lips ‘s’ that sounds slushy (lemah)

4. drg. H. Rinaldi, BU, MS, SP. KGA/M10
DEDICATED FOR MOLAR PSPDG UMY 2012
ARTICULATION
o Mengacu pada suara yang dihasilkan
Modifikasi system pernapasan
Macam katup sepanjang saluran bicara
Bibir
Lidah
Gigi dan palatum
o Gangguan
Distorsi ringan pada suara (cadel/celat)
Masih mudah untuk dipahami (parah)
KESALAHAN KLASIFIKASI
o Kelainan suara saat bicara
‘cu’ untuk ‘cup’
‘te-y’ untuk ‘teddy’
o Penggantian suara
‘wed’ untuk ‘red’
‘tun’ untuk ‘sun’
o Distorsi
Bibir bagian lateral mengeluarkan suara yang lemah

5. drg. H. Rinaldi, BU, MS, SP. KGA/M10
DEDICATED FOR MOLAR PSPDG UMY 2012
DEVELOPMENT OF SOUNDS WITH AGE
AGE SOUNDS CORRECTLY PRODUCED COMMENTS
_______________________________________________________________________
2 m, n, h sometimes difficult to understand
(for unfamilliar people)
2,5 p, b, ing, w, d, g
3 y, k, f, sh by 3 years, 80%-90%, should be easily
understood
3,5 t, ch, dge
4 l, s (zh) blends of sounds (e,g,st,cl,dr) are acquired
later than individual sounds but are usually
mastered by 5 year
4 r
5,5 z
7,5 th
8
LANGUAGE
o Much more complex
o Receptive l
(ability to understand language)
o Expressive l
(ability to initiate communication)
o Problems learning language
Difficulties interpreting the meaning of words and gesture
Excessive delay in the production of first words and phrases
Lack of understanding of questions and instructions
Inability to produce sentences that are grammatically correct
Inability to participate in conversations

6. drg. H. Rinaldi, BU, MS, SP. KGA/M10
DEDICATED FOR MOLAR PSPDG UMY 2012
PERKEMBANGAN SUARA BERDASARKAN USIA
USIA SUARA YANG DIUCAPKAN DENGAN BAIK KETERANGAN
_______________________________________________________________________
2 m, n, h terkadang sulit dipahami
(bagi orang yang tak terbiasa)
2,5 p, b, ing, w, d, g
3 y, k, f, sh 3 tahun, 80%-90%, mudah dipahami
3,5 t, ch, dge
4 l, s (zh) pengucapan gabungan suara (e,g,st,cl,dr)
lebih lambat daripada lainnya tapi biasanya
akan bisa dikuasai saat berusia 5 tahun
4 r
5,5 z
7,5 th
8
BAHASA
o Lebih kompleks
o Penerimaan l
(kemampuan memahami bahasa)
o Ekspresi l
(kemampuan memulai dan merespon komunikasi)
o Gangguan dalam berbahasa
Kesulitan menginterpretasikan bahasa dan gestur
Lambat dalam mengucapkan kata-kata pertama dan frase
Lemah dalam memahami pertanyaan dan instruksi
Tidak mampu mengucapkan kalimat dengan susunan yang tepat
Tidak mampu berpartisipasi dalam percakapan/komunikasi banyak orang

7. drg. H. Rinaldi, BU, MS, SP. KGA/M10
DEDICATED FOR MOLAR PSPDG UMY 2012
VOICE
o Abnormal voice quality
o Abnormal resonance or tone
o Inappropriate loudness levels
o Problems with pitch
o Causes of voice problems
Vocal abuse and misuse
Neurogical problems
Vocal polyps
Muscular pathology
Vocal cord paralysis
Irritants causes by exposure to smoking or aerosol sprays
Physical conditions: cleft palate, laryngectomy, hearing loss
FLUENCY
o Refers to the smooth flow of speech
o Where there are interruptions in the flow of speech, stuttering occurs (gagap)
o The phenomenon is not a disordered pattern that will persist
o The problems is not psychological in origin and nor is there evidence of decreased
mental aptitude (3% in males)
STRUCTURAL ANOMALIES AND THEIR RELATIONSHIP TO SPEECH
These important diagnostic procedures are often critical in the diagnosis of structural
and functional problems affecting feeding skills and speech production
o Dental Anomalies
Severe Class III Malocclusion
(‘s’, ‘z’, ‘t’, ‘d’, ‘l’ and ‘n’)
Severe Class II Malocclusion
(‘p’, ‘b’ and ‘m’)

8. drg. H. Rinaldi, BU, MS, SP. KGA/M10
DEDICATED FOR MOLAR PSPDG UMY 2012
SUARA
o Kualitas suara abnormal
o Resonansi atau nada abnormal
o Kekerasan level nada yang tidak tepat
o Gangguan pada control nada
o Penyebab gangguan suara
Penyalahgunaan suara/vokal
Gangguan saraf
Vocal polyps
Gangguan pada otot
Kelumpuhan pada vocal cord
Iritasi karena merokok atau semprotan aerosol
Kondisi fisik : palatoschisis, laryngectomy, lemah pendengaran
KELANCARAN/KEFASIHAN
o Mengacu pada kelancaran berbicara
o Terdapat hambatan pada aliran suara sehingga timbul gagap
o Bukan suatu kelainan yang tetap (bisa diperbaiki)
o Masalah utamanya bukan pada psikolohi tapi juga menurunnya kemampuan mental
(3% pada laki-laki)
STRUKTUR ANOMALI DAN HUBUNGANNYA DENGAN KEMAMPUAN BICARA
Prosedur diagnosis seringkali dibutuhkan secara kritis (suatu keharusan) dalam
mendiagnosis gangguan struktur dan fungsi yang mempengaruhi kemampuan
makan/menelan dan bicara
o Anomali Gigi
Severe Class III Malocclusion
(‘s’, ‘z’, ‘t’, ‘d’, ‘l’ and ‘n’)
Severe Class II Malocclusion
(‘p’, ‘b’ and ‘m’)

9. drg. H. Rinaldi, BU, MS, SP. KGA/M10
DEDICATED FOR MOLAR PSPDG UMY 2012
Maxillary Collapse
Maxillary Collapse
(‘s’, ‘z’, ‘sh’, ‘ch’ and ‘dge’)
Absence of teeth
o Palatal Anomalies
Palatal normally
Soft palate and Pharyngeal wall work simultaneously to close off the nasopharynx
during speech production and while swallowing. Prevents excessive airflow into nasal
cavity during speech. Prevents nasal regurgitation during the swallow.
Palatal abnormality
Often escape of food and liquid into the nose. Speech is nasal and breathy. Sounds
are unclear and volume may be reduced.
- Cleft palate (with or without cleft lip)
- Sub mucous cleft palate, characterized by a bifid uvula, separation of the
palatal muscles, which results in a midline furrow on the soft palate and a
notching of the posterior margin of the hard palate
- Congenital palatal abnormalities: short palate, deep nasopharynx,
uncoordinated or inefficient velopharyngeal movement
- Acquired palatal abnormalities resulting from neurological damage, from
surgery or from neoplasm
o LINGUAL ANOMALIES
Abnormalities of tongue may affect the precision, range and speed of tongue
movement, resulting in speech or feeding difficulties. The most common expression of a
lingual anomaly is the tongue tie (Ankyloglossia).
- Substitutions and distortion of tongue tip sounds caused by restricted
elevation of the tongue tip (‘l’, ‘t’, ‘d’, ‘n’, ‘s’, ‘z’)
- Slower than normal speech rate
- Reduced speech precision during shouting
- Feeding difficulties, such as difficulty sucking in infancy and persistent
‘messy’ eating

10. drg. H. Rinaldi, BU, MS, SP. KGA/M10
DEDICATED FOR MOLAR PSPDG UMY 2012
Maxillary Collapse
Maxillary Collapse
(‘s’, ‘z’, ‘sh’, ‘ch’ and ‘dge’)
Absence of teeth
o Anomali Palatum
Palatal normal
Palatal lunak dan dinding pharyngeal bekerja dengan menstimulasi nasopharynx
untuk menutup ketika berbicara dan menelan. Mencegah masuknya aliran udara ke dalam
kavitas nasal ketika berbicara. Mencegah regurgitasi nasal ketika menelan.
Palatal abnormal
Seringkali makanan dan minuman masuk ke dalam nasal. Suara tidak jelas dan
volumenya rendah.
- Palatoschisis (dengan atau tanpa cleft bibir)
- Cleft palatal submukosa, memiliki ciri adanya bifid uvula, otot palatal
terpisah, yang menghasilkan alur midline pada palatal lunak dan bentukan
garis posterior pada palatal keras
- Palatal abnormal kongenital : palatal rendah, nasopharynx dalam,
pergerakan velopharyngeal yang tidak terkoordinasi dan efisien
- Kelainan palatal karena kerusakan saraf, akibat operasi atau neoplasma
o LINGUAL ANOMALIES
Kelainan lidah mempengaruhi peletakan, jangkauan dan kecepatan pergerakan lidah,
yang mengakibatkan kesulitan dalam berbicara atau makan. Kelainan lidah yang paling
sering adalah Ankyloglossia
- Pergantian dan distorsi dari ujung lidah disebabkan elevasi/kemampuan
gerak lidah yang terbatas (‘l’, ‘t’, ‘d’, ‘n’, ‘s’, ‘z’)
- Lebih lambat dibandingkan kecepatan bicara rata-rata
- Berkurangnya presisi bicara saat berteriak
- Kesulitan makan/menelan, misalnya kelitan menghisap saat bayi