Project of psycholinguistics

Project of
Psycholinguistics
Dysarthria
The reason of research was to find the reasons and
causes of the disease (Dysarthria)
[Type the author name]
Group Members
Sadaf syeda
Iqra Khan
Iram Naqvi
Adeena Anwaar
Tahira Parveen

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Table of contents:
Sr.# Topic Page #
1. Abstract 2
2. Introduction 3
3. Aim of study 8
4. Purpose statement 8
5. Research procedure 8
6. Literature Review 9
7. Research Methodology 13
8. Findings and Data analysis 14
9. Suggestions and Recommendation 36
10. Conclusion 38
11. References 39

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Abstract
There are several problems which disturbs the sentence structure. One of them is
language disorder. It totally disturbs the language structure, pronunciation,
sentence pattern or in simple words the overall language disorder can be created
due to several reasons.
There are several reasons for the language disorders , one of them is Dysarthria, In
this study it is focused the causes and symptoms due to which language disorders
are created in a human brain.
After the complete discussion and detailed study about the Dysarthria, it is
suggested how it can be improved. So that language disorder could be minimized.

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Introduction:
What is dysarthria?
Dysarthria is a motor speech disorder. The muscles of the mouth, face, and
respiratory system may become weak, move slowly, or not move at all after a
stroke or other brain injury. The type and severity of dysarthria depend on which
area of the nervous system is affected.
Some causes of dysarthria include stroke, head injury, cerebral palsy, and muscular
dystrophy. Both children and adults can have dysarthria.
What are some signs or symptoms of dysarthria?
A person with dysarthria may experience any of the following symptoms,
depending on the extent and location of damage to the nervous system:
 "Slurred" speech
Speaking softly or barely able to whisper
 Slow rate of speech
 Rapid rate of speech with a "mumbling" quality
 Limited tongue, lip, and jaw movement
 Abnormal intonation (rhythm) when speaking
 Changes in vocal quality ("nasal" speech or sounding "stuffy")
 Hoarseness
 Breathiness
 Drooling or poor control of saliva
 Chewing and swallowing difficulty

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How is dysarthria diagnosed?
A speech-language pathologist (SLP) can evaluate a person with speech difficulties
and determine the nature and severity of the problem. The SLP will look at
movement of the lips, tongue, and face, as well as breath support for speech, voice
quality, and more.
Another motor speech disorder is apraxia. An important role of the SLP is to
determine whether the person's speech problems are due to dysarthria, apraxia, or
both.
SLPs work in many places, including hospitals, clinics, nursing homes, and
schools. Sometimes an SLP can come to a person's home. To contact a speech-
language pathologist visit ASHA's Find a Professional.
What treatment is available for people with dysarthria?
Treatment depends on the cause, type, and severity of the symptoms. An SLP
works with the individual to improve communication abilities.
Possible Goals of Treatment
 Slowing the rate of speech
 Improving the breath support so the person can speak more loudly
 Strengthening muscles
 Increasing mouth, tongue, and lip movement
 Improving articulation so that speech is more clear
 Teaching caregivers, family members, and teachers strategies to better
communicate with the person with dysarthria

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 In severe cases, learning to use alternative means of communication (e.g., simple
gestures, alphabet boards, or electronic or computer-based equipment)
What can I do to communicate better with a person with dysarthria?
It is important for both the person with dysarthria and the people he or she
communicates with to work together to improve interactions. Here are some tips
for both speaker and listener.
Tips for the Person With Dysarthria
 Introduce your topic with a single word or short phrase before beginning to
speak in more complete sentences
 Check with the listeners to make sure that they understand you
 Speak slowly and loudly; pause frequently
 Try to limit conversations when you feel tired, when your speech will be harder
to understand
 If you become frustrated, try to use other methods, such as pointing or gesturing,
to get your message across, or take a rest and try again later
Children may need additional help to remember to use these strategies.
Tips for the Listener
 Reduce distractions and background noise
 Pay attention to the speaker
 Watch the person as he or she talks
 Let the speaker know when you have difficulty understanding him or her
 Repeat only the part of the message that you understood so that the speaker does
not have to repeat the entire message

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 If you still don't understand the message, ask yes/no questions or have the
speaker write his or her message to you
What other organizations have information on dysarthria and services for
people with dysarthria?
This list is not exhaustive and inclusion does not imply endorsement of the
organization or content of the Web site by ASHA.
 Mayo Clinic
 FCC speech-to-speech services access numbers
 Speech Communication Assistance by Telephone, Inc.
What causes dysarthria?
Dysarthria is caused by many different conditions that involve the nervous system,
including the following:
 Stroke
 Brain injury
 Tumors
 Cerebral palsy
 Parkinson's disease
 Lou Gehrig's disease/amyotrophic lateral sclerosis (ALS)
 Huntington's disease
 Multiple sclerosis
 Medications

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How common is dysarthria?
Information about the incidence and prevalence of motor speech disorders is
available in the ASHA report, Incidence and Prevalence of Speech, Voice, and
Language Disorders in Adults in the United States.
What are the types of dysarthria?
The following Web sites explain and define the many types of dysarthria.
 Cognitive Science Initiative: Language Lexicon
 The Neuroscience on the Web Series
How effective are speech-language pathology treatments for dysarthria?
ASHA produced a treatment efficacy summary on dysarthria [PDF] that describes
evidence about how well treatment works. This summary is useful not only to
individuals with dysarthria and their caregivers but also to insurance companies
considering payment for much needed services for dysarthria.
In addition, practice guidelines for dysarthria have been developed by the
Academy of Neurologic Communication Disorders & Sciences (ANCDS).

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Aim of study
Through this study the aim was to find out the language disorders in the dysarthria
patients, its causes, reason and the effects.
Its aim was also to find out the reasons and back ground causes which were the
main reasons of language disorders in the patients and how the patients were
affected to this disease.
Purpose Statement:
The purpose of this research was to identify “the causes and reasons of the
language disorders in the dysarthria patients”.
Research Means and Procedure
The hypotheses enunciated above entail the resort to several means of data
collection. To begin with, this research work is led through a qualitative analysis.
To inquire into the patients' relatives and doctors’ beliefs and viewpoints about the
approach, cause and the reasons of the disease, detail discussions were made with
them.

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Literature Review
Dysarthria is a frequent and persisting sequel to stroke and arises from varied
lesion locations. Although the presence of dysarthria is well documented, for
stroke there are scant data on presentation and intervention outcome. A literature
search was undertaken to evaluate
(a) The features of dysarthria in adult stroke populations relative to the
conventional Mayo system for classification, which was developed from diverse
pathological groups, and
(b) The current status of evidence for the effectiveness of intervention in dysarthria
caused by stroke. A narrative review of results is presented. The limited data
available indicate that, regardless of stroke location, imprecise articulation and
slow speaking rate are consistent
This review summarizes and discusses the literature on speech deficits in cerebellar
diseases and on the topography of cerebellar dysarthria. Clinical descriptions of
dysarthric features in cerebellar diseases, parametric investigations of ataxic
dysarthria, and experimental studies in animals concerning the effects of lesions on
vocalization and the representation of sensorimotor orofacial functions in the
cerebellum are considered. Signs of cerebellar dysarthria include a slowing down
of articulatory movements, increased variability of pitch and loudness, monotonous
and "scanning" speech, and articulatory impreciseness. The available data indicate
that the paramedian regions of the superior cerebellar hemispheres are relevant for
the development of cerebellar dysarthria.

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Dysarthria is more prevalent in left than in right hemisphere lesions. There is a
need for comprehensive, thorough analysis of dysarthria features, involving larger
populations, with stroke and other variables controlled and with appropriate age-
referenced control data. There is low level evidence for benefits arising from
intervention in stroke-related dysarthria. Because studies involve few participants,
without external control, and sometimes include stroke with other aetiologies, their
results lack the required weight for confident evidence-based practice.
The search and review of sourced material was carried out by the author. The
search was confined to publications in English between 1985 and May 2010 for
question a) and between January 2007 and May 2010 for question b). This shorter
time period for the latter was selected because of the existence of two
comprehensive intervention reviews on non-progressive dysarthria which
encompass, but are not confined to stroke (Sellars et al., 2005; Palmer & Enderby,
2007).
An initial search was conducted using MEDLINE. To address question a) stroke
was used in combination with dysarthria. To address question b) therapy was
added as a search term. MEDLINE applies additional related terms: stroke
(apoplexy; apoplexies; cerebral stroke; cerebrovascular accident; cerebrovascular
apoplexy; cerebrovascular stroke; strokes; vascular accident brain; cva); dysarthria
(dysarthrias; dysarthosis); therapy (therapeutic; management; treatment;
intervention; remedy; relief; amelioration; alleviation). For question a) 30290
references were raised, of which 586 were classified as 5*, having all search terms,
or their applied related terms, present and complete. For question b) 5298
references were raised of which 86 were classified as having all search terms

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present and complete. Abstracts of all 5* references were evaluated to determine
their relevance to the questions, according to the following inclusion criteria:
1) Data confined to participants with stroke or from which stroke specific data
could be clearly distinguished;
2) adult population;
3) Dysarthria diagnosis without accompanying apraxia of speech or aphemia
and clearly differentiated from any co-existing aphasia.
Additionally for question a):
4) Description of a range of speech parameters derived from specified tasks,
including connected speech: data confined to one parameter such as
articulation or phonation, or obtained from a single task, such as vowel
prolongation or rapid syllable repetition provides a narrow focus without
necessarily identifying the dimensions most commonly associated with
stroke;
5) Data from a minimum of 10 stroke participants, as the representativeness of
single case and small group descriptions cannot be determined. No lower
limit as to the number of participants was set for question b) because of the
small amount of outcome research.
Where more than one publication reported on the same participant group or a
subset thereof, the publication with the most complete and comprehensive data was
used. From the MEDLINE search, six discrete studies met the criteria for question
a) and six for question b). Applying the same inclusion criteria and timeframe,
Ingentaconnect, PsycINFO, LLBA and ANCDS databases were examined with a
view to sourcing any additional publications not indexed in MEDLINE. Additional

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search terms of vascular, CVA, infarction, intervention, speech, treatment and
rehabilitation were applied.
Reference lists for all qualifying material were also scanned and electronic and
hand searches were undertaken of relevant communication disorders journals
which may not be fully referenced in the databases through the time period.
Beyond the material sourced from MEDLINE these further searches provided one
additional source for question a) and one for question b), thus totalling seven
sources for questions a) and seven for b). Suitable to the heterogeneous nature of
the available data, the findings are presented in the form of a narrative review, with
associated discussion of key issues arising from the data. Such overviews of the
literature are defined as “comprehensive narrative syntheses of previously
published information” (Green, Johnson & Adams, 2006, p)
Speech and language therapy treatments for people with dysarthria have not been
tested in large clinical trials. Dysarthria is a speech problem which can be caused
by a number of brain disorders including conditions such as stroke and head injury.
Typical features of dysarthria include slurring of speech and quiet voice volume.
Psychological distress is often experienced by people with dysarthria. Speech and
language therapists employ a range of treatments to help people with dysarthria.
There are no large clinical trials which have tested whether these treatments are
effective.

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Research Methodology
Population
All the patients and the doctors of that government institution considered to be the
population for the study.
Sampling
6 patients and 3 teachers were considered to be the sample for the study
Instrument
Qualitative research was made for this purpose. Patients and doctors were
interviewed to collect the data.

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Findings and Data Analysis:
The research was conducted to find out the causes and the reasons of the language
disorders in the dysarthria patients. For this purposes the researchers were visited
to a medical institute and the several patients were visited and the discussions were
made with the patients, their relatives and the doctors in order to find out the
causes and the reasons of the dysarthria disease and then the language disorders
due to this disease. Furthermore observations were made by observing the patients
their behavior, way of talking, the use of language and the selections of the words.
After that a detail reports were made for each patient, in which their causes,
symptoms of disease, their treatment and their overall language disorders were
discussed. These reports are given as;
Patient: 1
 Name of Institute
The name of institute was General Hospital Lahore
 Name of Patient
Ehsan Elahi
 Gender
Male
 Age
22 years

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 Family status of disorder
Not Present
 Medical Examination
Blood pressure = 130/80
Pulse = 88
 Disorder
Aphasia and paralysis
 History of Patient
The patient went out with his friends in a night. He didn’t come back on that
night. Next day he was found in very serious condition. His friends had beaten
him with the back of pistol and he was sexually assorted by them badly. The
patient was admitted in NISHTAR hospital for 10 days, the doctors told that his
stomach was filled with a huge amount of poison. His poisonous material was
washed out and he stayed there for 10 days. Then they referred him to the
GENERAL hospital Lahore. Here in this hospital he spent 10 days in unit 1 of
neurology and then he was shifted to the unit 3 of neurology.
 Diagnoses
CNS = S1+S2
Power =5/15
Brain edema
Kidney damage

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 Duration in Hospital
Previous 2 months
Admitted on 24th
December 2012
 Causes of disorder
Poison
Stroke on the brain by the back of pistol
Sexual assort
 Symptoms
Body paralyze
Unconsciousness
Vomiting
Urine blockage
Abuses
 Voice Quality
Slurred speech
 Pitch
Low
 Stress
On lateral words

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 Narration
Half sentences
 Sentence Pattern
Wrong according to speaking
 Sound
Loud
 Language Disability
Unable to speak properly
Can’t produce complete sentences
 Gestures
He watches at the right side mostly
He answered to that questions which are not asked by him
He start laugh suddenly without any reason
He starts weep and cry suddenly
 Emotion
He could understand all the things and answered to the questions
 Medication
Tablet ziapine 100mg
Tablet Rivoril 20mg
Injection Methecobal
Injection Clopex

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 Treatment
 Medicines and injections
 Improvement
Now his right side of body is working properly. Left leg is also working
properly. His left arm has also some movement. He answered to the questions
in chunks of sentences.
 The above overall detail of this patient shows that he speaks himself, during
his speak he eats the words and give the stress on the lateral words of the
sentence. He speaks in the chunks. The emotions and the feelings can be
observed in his language. When he starts crying or laughing, the sentences
are broken into small chunks and the stress was put on the lateral words. The
sentence structure was totally wrong. He was producing high sounds and his
pitch was low. All these things show how his disease has affected his
language; how language disorders have been produced in his speak. His lip
movement, gestures, way of narration, his voice, pitch, sound and voice
quality all were defected due to his disease, these all are language disorders.

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Patient: 2
 Name of Patient
Mohammad Yusuf
 Gender
Male
 Age
75 years
Not present
 Disorder
Aphasia and paralysis
The Patient is diabetic for 20 years and got CVA one year back of left side. One
of his legs is cut because of diabetes. He got first stroke a month ago for 5 to 6
minutes. The patient is unconscious and doesn’t recognizing anyone. He is also
not replying if someone talks to him, his eyes movement is also weird. He
stares at a point and doesn’t response at any voice. The patient is uttering
incomplete words which are not understandable he is just producing sounds.

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Sometimes he moves his right arm while making sounds. Patient’s condition is
very serious.
 Diagnoses
CNS
Diabetes
Stroke
Hypertension
 Symptoms
Left side paralyzed
Unconsciousness
Abuses
 Voice Quality
Slurred speech
 Pitch
High
 Stress
There is no stress on any word

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 Narration
Just producing few sounds which are not understandable
No pattern
Yes
 Gestures
He watches at the same point only
He doesn’t answer to any questions
Sometimes he tries to speak but he can’t
His tongue position is same he is unable to move his tongue that’s why he can’t
speak or utter words
 Emotion
He is behaving like emotionless he isn’t recognizing anyone not even his own
son.
 Medication
Tab: Maxolon,
Inj : Dianpam,
Tab: Rovator.
 Treatment
Medicines and injections

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 Improvement
Patient is very serious.
 The above overall detail of this patient shows that the patient was not able to
speak properly. It was his 2nd
attack of stroke. He was trying to produce the
sounds but he was unable. He was only uttering the sound not complete
words, chunks, phrases or sentences. He was producing low sounds with high
pitch. All these things show how his disease has affected his language badly.
His all qualities of speaking have been damaged badly. These all are
language disorders.
Patient: 3
 Name of Patient
Sarwar
 Gender
Male
 Age
54 years
Not signified

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 Disorder
Stroke with paralysis
According to attending patient was admitted from previous 10 days, in a usual
status of health one day back then he developed right side weakness and patients
fell down on right side. Patient is also unable to speak for 1 day.
 Diagnoses
CNS
Smoking
Stroke
Hypertension
 Symptoms
Left leg or right arm paralysis for 12 hours
Vomiting=1 day
Abuses
 Voice Quality
Zero movement of lips
 Pitch

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Very low and not able to hear
 Stress
No stress on words
 Narration
He was able to narrate some sounds but not properly
No pattern
Yes
 Gestures
Only seeing
He doesn’t answer to any questions
Speaking is very poor
Response is zero
 Emotion
No understanding and No recognition
 Medication
Tab=Disprine
Tab=Sane. 20g

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Tab=Ulcerex
Tab= Ceftriaxone 1 gm.
Tab= Zestil 5mg
 Treatment
Medicines and injections
 Improvement
Not satisfied
 Analysis
The above overall details of this patient show that he was a patient of
language disorder. He was trying to answer the question but he was unable to
answer in complete sense and sentences. He was only able to utter the words only
for example “a” “ba”etc. He was watching to all but not understanding anything.
He was only watching to his surroundings. He was unconscious and unable to
speak. All these things show how his disease has affected his language and his
language disorders.
Patient: 4
 The name of institute was General Hospital Lahore
 Name of Patient
Ismail khan

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 Gender
Male
 Age
60
Not present
 Disorder
SOB
The patient he was in usual state of health two days back then he developed
fever palpitation than took medicine for fever and was relived. But the
patient was not comfortable so he went to a local doctor next day. His blood
pressure was 220/116. He took medicines for the blood pressure yesterday.
When the patient awoke up in the morning his left (R+) side weakness and
Aphasia
 Diagnoses
Aphasia
Paralysis
Heart attack
Blood pressure

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Body Itchy
 Symptoms
Fever
R+ weakness
 Voice Quality
Slurred
 Pitch
Low
 Stress
Balance
 Narration
He was not able to narrate the complete sentences
Wrong
Yes

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 Gestures
He was able to understand only few things
He was smiling without reason
 Emotion
Strange
 Medication
Tab Ciproflex
Tab dispreen
Tab Ceftriancone
Tab Illcerene
Tab Rovata
 Treatment
Chest,
Paralyze
Nebulization
Position change
 Improvement
He was recovering very slowly
 The above overall detail of the patient shows that he was suffering from the
language disorder. Patient’s speech was slurred and he was producing

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complete sentences but that were grammatically wrong. His sound was high
and pitch was low. His body language was strange. He was smiling himself
and doing strange things. He was restless and moving continuously. His
tongue movement was disturbed. These all are the language disorders.
Patient: 5
 Name of Patient
Imtiaz Ali
 Gender
Male
 Age
15
Not present
 Disorder
Stroke

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The patient came in emergency with complaints of fits from last 25 days for
5-7 minutes
 Diagnoses
CVA
Paralysis
Fits
Blood pressure
Water in kidneys
 Symptoms
Unconscious
Right side paralyze
 Voice Quality
Slurred
 Pitch
Low
 Stress
Balance

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 Narration
He was not able to narrate the complete sentences
Wrong
Yes
 Gestures
He was able to understand everything
 Emotion
Good
 Medication
Tab Tenormin
Tab Asprin
 Treatment
3 months course of prescribed medicine
 Improvement
He was recovering very fastly
 The above overall detail of the patient shows that he was suffering from
language disorder. When he was admitted he was passing through fits those
effects his speech badly. He was not able to speak the words or sentences

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early. His speech was slurred. His sound was high and pitch was low. For the
short duration he wasn’t able to speak any word. These all are language
disorders
Patient: 6
 Name of Patient
Karamat Ali
 Gender
Male
 Age
35
 Family status
Not Present
 Disorder
Stroke
Brain injury

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The patient fell in this disease due to an accident on road. He is suffering
from brain injury due to the road accident after that this brain injury lead
him toward dysarthria (It is a speech disorder resulting from weakness,
paralysis, that is of neurological etiology).
 Diagnoses
Brain damage
 Causes
Accident
 Symptoms
Slurred speed
Vomiting with blood
 Voice quality
Low
 Pitch
High
 Stress
No stress

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 Narration
No
No
He was unable to speak
 Gestures
He was telling his things by hands
He was answering the questions by hands
 Emotions
He was able to understand everything
He was able to move to move his lip, tongue and body.
 Medication
Cefspan 400mg ( BID)
Omega 40mg (BID)
Voren Ing. ( BID)
Dicloran 40mg (TID)
Panadol 500mg( TID)

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 Treatment
To avoid conversation when you are tired.
Computer to type out words.
Flip cards with words or symbols.
It’s important to maintain a relaxed, calm environment reduce noise music
and other stimuli during communication.
 Improvement
When he was admitted, he was restless and did not understanding anything.
He was not answering to anyone. He was unconscious first. Now he was
able to understand and answer the things. Now he was in his senses.
 The above overall detail of the patient shows that he was suffering from
language disorder. During his speak he was unable to speak complete
sentences. He was uttering the chunks of sentences. His damage of language
muscles was very severing so that doctors advised him to give rest to his
mouth (language muscles) for a little duration. His sound was loud and pitch
was low.

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Suggestions and Recommendations:
According to the overall it is suggested as;
Suggestions for Teachers:
 Learn as much as you can about the student’s specific disability. Speech-
language impairments differ considerably from one another, so it’s
important to know the specific impairment and how it affects the student’s
communication abilities.
 Recognize that you can make an enormous difference in this student’s life!
Find out what the student’s strengths and interests are, and emphasize them.
Create opportunities for success.
 If you are not part of the student’s IEP team, ask for a copy of his or her IEP.
The student’s educational goals will be listed there, as well as the services
and classroom accommodations he or she is to receive.
 Make sure that needed accommodations are provided for classwork,
homework, and testing. These will help the student learn successfully.
 Consult with others (e.g., special educators, the SLP) who can help you
identify strategies for teaching and supporting this student, ways to adapt the
curriculum, and how to address the student’s IEP goals in your classroom.
 Find out if your state or school district has materials or resources available to
help educators address the learning needs of children with speech or
language impairments. It’s amazing how many do!
 Communicate with the student’s parents. Regularly share information about
how the student is doing at school and at home.

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Suggestions for Parents
 Learn the specifics of your child’s speech or language impairment. The more
you know, the more you can help yourself and your child.
 Be patient. Your child, like every child, has a whole lifetime to learn and
grow.
 Meet with the school and develop an IEP to address your child’s needs. Be
your child’s advocate. You know your son or daughter best, share what you
know.
 Be well informed about the speech-language therapy your son or daughter is
receiving. Talk with the SLP, find out how to augment and enrich the
therapy at home and in other environments. Also find out what not to do!
 Give your child chores. Chores build confidence and ability. Keep your
child’s age, attention span, and abilities in mind. Break down jobs into
smaller steps. Explain what to do, step by step, until the job is done.
Demonstrate. Provide help when it’s needed. Praise a job (or part of a job)
well done.
 Listen to your child. Don’t rush to fill gaps or make corrections. Conversely,
don’t force your child to speak. Be aware of the other ways in which
communication takes place between people.
 Talk to other parents whose children have a similar speech or language
impairment. Parents can share practical advice and emotional support. Visit
NICHCY’s State Sheets and find a parent group near you. Look in the
Disability-Specific section, under “speech-language.”
 Keep in touch with your child’s teachers. Offer support. Demonstrate any
assistive technology your child uses and provide any information teachers

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will need. Find out how you can augment your child’s school learning at
home.
Conclusion:
Speech and language skills develop in childhood according to fairly well-defined
milestones Parents and other caregivers may become concerned if a child’s
language seems noticeably behind (or different from) the language of same-aged
peers. This may motivate parents to investigate further and, eventually, to have the
child evaluated by a professional. The language disorders affect the language
totally which affects the personality of a person completely. Without a language
any person is nothing and with the language disorders he/she completely or
partially feels a sort of hopeless and misery.
The most of the language disorders are developed in the childhood or in the young
age mostly, especially in those who cannot control their emotions. So there should
be such type of efforts done at the domestic, social and government level to wash
the mind of such persons.

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References
1 |Minnesota Department of Education. (2010). Speech or language impairments.
Online at:
http://education.state.mn.us/MDE/EdExc/SpecEdClass/DisabCateg/SpeechLangIm
pair/index.html
2 | Boyse, K. (2008). Speech and language delay and disorder. Retrieved from the
University of Michigan Health System website:
http://www.med.umich.edu/yourchild/topics/speech.htm
3 | Ibid.
4 | American Speech-Language-Hearing Association. (n.d.). Speech sound
disorders: Articulation and phonological processes. Online at:
http://www.asha.org/public/speech/disorders/speechsounddisorders.htm
5 | Cincinnati Children’s Hospital. (n.d.). Speech conditions and diagnoses. Online
at: http://www.cincinnatichildrens.org/health/info/speech/diagnose/speech-
disorder.htm
6 | National Institute on Deafness and Other Communication Disorders. (2002).
What is voice? What is speech? What is language? Online at:
http://www.nidcd.nih.gov/health/voice/pages/whatis_vsl.aspx
7 | American Academy of Otolaryngology — Head and Neck Surgery. (n.d.). Fact
sheet: About your voice. Online at:
http://www.entnet.org/HealthInformation/aboutVoice.cfm
8 | Boyse, K. (2008). Speech and language delay and disorder. Retrieved from the
University of Michigan Health System website:
http://www.med.umich.edu/yourchild/topics/speech.htm
9 | Encyclopedia of Nursing & Allied Health. (n.d.). Language disorders. Online
at: http://www.enotes.com/nursing-encyclopedia/language-disorders
10 | Ibid.

41 | P a g e
11 | U.S. Department of Education. (2010, December). Twenty-ninth annual report
to Congress on the Implementation of the Individuals with Disabilities Education
Act: 2007. Online at: http://www2.ed.gov/about/reports/annual/osep/2007/parts-b-
c/index.html
Sharp HM, Hillenbrand K. Speech and language development and disorders in
children. Pediatr Clin North Am. 2008;55:1159-1173.
Simms MD. Language disorders in children: classification and clinical syndromes.
Pediatr Clin North Am. 2007;54:437-467.
Simms MD, Schum RL. Language development and communication disorders, In:
Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of
Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap32.

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