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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4578_Библиотеки_им_академика_М_И_Перельмана
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phoneme-specific paern of substituting nasal fricatives for /s/, with no
oral placement.
FIGURE 5-11 Turbulent nasal fricative.
Mid-Dorsum Palatal Stop
FIGURE 5-12 Mid-dorsum palatal stop.
• A stop consonant made in the approximate place of /j/, the mid-palatal
glide (i.e., lingual mid-dorsum contacts mid-palate [Trost, 1981]); some
youngsters may produce this as a double articulation using alveolar
and velar placements simultaneously (Gibbon and Crampin, 2002)
• Voiced or unvoiced.
• Airflow stopped and released, comparable to other oral stops
• Typically substituted for /t/ or /k/ (voiceless) and /d/ or /g/ (voiced)
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• Perceptually, it is a cross between /t/ and /k/ or /d/ and /g/; when your
ears ask, “Is that a /t/ or a /k/?” you most likely have heard a middorsum palatal stop
• Somewhat controversial as a “compensatory” articulation (see
discussion in Peterson-Falzone, et al., 2010, Chapter 7) because it:
— Is the only compensatory articulation that does not
have a postuvular or nonoral place of articulation; is
produced anterior to the VP valve
— May be the result of an oral place compromise
between anterior place and posterior place, learned
in early speech sound practice or babbling as the
tongue aempts to fill the unoperated cleft space in
search of an articulatory contact surface
— May be the result of a placement learned in the
aempt to use the tongue mid-dorsum to occlude a
residual anterior or mid-palatal fistula
— Has been observed as a transient production in early
speech development of some children without clefts
(Chapman and Hardin, 1992)
As can be seen from the preceding descriptions of compensatory
articulations, the predominant placement error is a backed or retracted
articulation. Place of production is realized or moved posterior to the
target place. Compensatory articulations are regarded as maladaptive
behaviors because they are substitutions that are not phonemic for the
ambient language; they are deviant in place of production—most are
nonoral—and they are perceptually deviant as well (Boxes 5-6 and 5-7).
Box 5-6
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A Note on the Mid-Dorsum Palatal Stop
The mid-dorsum palatal stop may be part of a palatalization paern or
process frequently seen in speakers with repaired cleft palate. From
this perspective, it may be a beer fit with the group of backed oral
productions discussed next (Trost-Cardamone, 2013), all of which are
dorsum to hard or soft palate articulations. However, as pointed out by
Peterson-Falzone, et al. (2010), “backed” would apply only when the
mid-dorsum palatal stop replaces a /t/ or a /d/. This emphasizes the
need for more systematic study of compensatory articulations and their
error paerns.
Box 5-7
Two Additional Compensatory Maneuvers
1. Some youngsters with VPI employ ingressive airflow to build oral
pressure. This may be heard on any of the high pressure consonants.
In our experience it is more often heard on /t, d/ and /s/, and with /t/
and /d/ it may be perceptually realized as a “click.” If this behavior
persists after successful physical management, therapy will be
required to teach egressive/outgoing or “pulmonic” airflow for
affected sounds. Examples of children using ingressive airflow are
provided in Video 5-5
.
2. Some youngsters with VPI and nasal emission evidence a nasal
grimace by contracting the nasal alae in an aempt to stop the nasal
emission. This behavior should disappear after successful surgical
management. If it persists, it is likely that surgery has not been
successful or that therapy is indicated to eliminate the behavior and
any associated learned nasal emission.
Compensatory Articulations as Coproductions
The term “coproduction” is comparable to the term “double
articulation,” which was used by Morley (1970) and others to follow
(Gibbon and Crampin, 2002; Grunwell, 1993; Hardcastle et al., 1989;
John et al., 2006; Sell et al., 1994; Whitehill et al., 1995).
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Gloal stops and pharyngeal fricatives can be coproduced with the
target place. In a compensatory coproduction, the speaker
simultaneously articulates at two places of production and uses one
manner of production. For example, as shown in Figure 5-13, A, the /b/
in “bay” is realized as a compensatory coproduction, that is, with lip
closure for the oral stop /b/ and with simultaneous a gloal stop
production. Thus, the listener sees the (bilabial) /b/ gesture but hears the
gloal stop. By contrast, a gloal stop substitution for the target /b/ is
illustrated in Figure 5-13, B. Note the single (gloal) place of stop
closure and the open lips. Gloal stop coproduction and gloal stop
substitution both look different and sound different.
You may want to relisten to the speakers in Audios 5-10
and 5-13 who
coproduce gloal stops.
FIGURE 5-13 A, Glottal stop coproduction in the word “bay.” B,
Glottal stop substitution in the word “bay.”
Compensatory articulations, corresponding phonetic symbols, and
the target sounds they replace are summarized in Table 5-2.
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TABLE 5-2
Compensatory Articulations and the Target Sounds They Replace
COMPENSATORY/MALADAPTIVE
MISARTICULATIONS
PHONETIC SYMBOL
TARGET PHONEME SUBSTITUTIONS AND
COPRODUCTIONS
UNVOICED VOICED SUBSTITUTIONS COPRODUCTIONS
Gloal stop
Any pressure
consonant (typically
stops)
Any pressure
consonant (typically
stops)
Pharyngeal affricate
Oral affricates Affricates
Pharyngeal fricative
Sibilant fricatives ±
oral affricates
Sibilant fricatives,
affricates
Pharyngeal stop
/k/, /g/ None
Nasal fricative
Nonturbulent
Learned: Sibilant
fricatives, affricates &
stops
Obligatory: Any
pressure consonant
None
Turbulent
Learned: Sibilant
fricatives, affricates &
stops
None
Mid-dorsum palatal stop
or
or
/t/, /d/, /k/, /g/ None
Notes:
1. As of this writing, there is no ExtIPA symbol for pharyngeal stop.
2. Turbulent nasal fricatives are observed more frequently in learned/intentional
patterns (i.e., phoneme-specific).
3. This accounting of CA substitution patterns and of nasal fricative substitution
patterns, in particular, is based largely on expert opinion.
Modified from Peterson-Falzone SJ, Trost-Cardamone JE, Karnell MP, et al: The
clinician's guide to treating cleft palate speech, St. Louis, 2006, Mosby-Elsevier, and
Peterson-Falzone SJ, Hardin-Jones MA, Karnell MJ: Cleft palate speech, ed 4, St.
Louis, 2010, Mosby.
Table 5-3 displays these errors by place and manner of production. To
summarize “by nonoral place,” these are nasal (nasal cavity),
velopharyngeal (nasopharynx/VP port), pharyngeal (with
linguapharyngeal placement at various points within the pharynx), and
laryngeal (glois, vocal folds). Figure 5-14 presents a graphic
illustration of the nonoral places of production that characterize the
gloal, pharyngeal, and nasal compensatory articulations. The oral
placements for the nasal fricatives are not shown.
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TABLE 5-3
Nonoral Compensatory Articulations by Place and Manner
NASAL
PHARYNGEAL
LARYNGEAL (GLOTTAL)
VELOPHARYNGEAL LINGUAPHARYNGEAL
Stop
Fricative
Affricate
FIGURE 5-14 Schematic illustration of nonoral places of
compensatory articulations.
At this point, you may wish to view Video 5-6
titled, “Compensatory
Misarticulations…” which provides excerpts from the teaching
videotape by Trost-Cardamone (1987).
Backed Oral Productions
Although atypical articulations, backed oral productions have a lesser
impact on speech understandability and acceptability. They are less
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severe misarticulations that nevertheless contribute to or flavor the
overall paern of articulatory backing that characterizes cleft palate
speech. By definition, these misarticulations may include any consonant
that is backed from its normal oral place but still remains oral. They also
are referred to as retracted articulations. Lohmander-Agerskov (1998)
considered retracted articulations to be compensatory in response to the
unoperated cleft or fistula in the hard palate commonly seen in children
who undergo primary veloplasty with delayed hard palate closure that
affects early speech sound learning. However, as SLPs experienced with
cleft palate speech know well, children in the United States, most of
whom undergo one-stage palatoplasty by or around their first birthday,
also evidence these paerns. Mid-dorsum palatal fricative, velar
fricative, and velarized tip alveolar sonorants /n/ and /l/ are more
commonly observed in cleft palate speakers. Videos 5-7
and 5-8 show
boys with repaired clefts using velar fricatives for sibilants and even
occasionally for a stop consonant. Note that, despite these backed
placements, they are still mostly intelligible. The boy in Video 5-8 has
the added complication of inconsistent use of gloal stops, and so is
somewhat less understandable than the boy in Video 5-7. Velarized
sonorant /r/ is less commonly observed. These backed oral productions
are described next.
Mid-Dorsum Palatal Fricative
• A voiced or unvoiced fricative consonant made in the approximate
place of /j/, the midpalatal glide; similar in configuration to middorsum palatal stop
• Lingual mid-dorsum approximates mid-palate; this distinguishes it from
the blade alveolar palatal fricatives /
/ and / /
• More often heard in voiceless form
• Perceptually, sounds like a “cat hiss”
• Used as a substitution for sibilant fricatives, especially /s/ and /z/, and
affricates
Velar Fricative
• A voiced or unvoiced fricative made in the same place as the velar
stops /k, g/; a fricative manner produced in velar place
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— /k/ → /x/
— /g/ → /
/
• Typically substituted for sibilant fricatives and sometimes affricates
because of backing of target place for these sounds
• Perceptually, is distinct from pharyngeal fricative; sounds like a
sustained /k:/ or /g:/ (almost like a cat hiss except a lile farther back)
Velarized Tip Alveolar Sonorants
• Tip alveolar sonorants become velar sonorants:
— Nasal sonorant /n/ → /
/
— Liquid sonorant /l/ → /
/
• Also observed in otherwise normal speakers without clefts
Sonorants can also be termed approximants.
Velarized or Uvular Sonorant
or
• /r/ →
• /r/ →
• Also observed in otherwise normal speakers without clefts
Table 5-4 summarizes these backed oral productions.
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TABLE 5-4
Backed Oral Productions
PHONETIC SYMBOL
BACKED PRODUCTION UNVOICED VOICED TARGET PHONEMES REPLACED
Mid-dorsum palatal fricative [Ç] [ʝ] Sibilant fricatives, especially /s,z/, and affricates
Velar fricative [x] [Ɣ] Sibilant fricatives and affricates
Velarized alveolar sonorants [ŋ]
[
]
/n/
/l/
Velarized liquid sonorant
[rɣ]
/r/
Uvular liquid sonorant [ʁ] /r/
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Adaptive Oral Misarticulations
Adaptive oral misarticulations occur in response to oral structural
deviations (not VPI) and are for the most part obligatory (Golding-
Kushner, 1995). They include speech sound errors that result from
dental deviations, occlusal deviations, and lip incompetency secondary
to malocclusion, surgical repair, or both. Adaptive oral misarticulations
are observed more often in speakers with cleft lip with or without cleft
palate than in isolated cleft palate. They are adaptive behaviors in that
speech gestures adapt to defective structures and yield perceptually
recognizable articulatory targets. As such, adaptive oral
misarticulations are seen in populations without clefts including
persons with acquired disorders (as in head and neck cancers) or
congenital disorders (e.g., Moebius and Beckwith-Wiedemann
syndromes), as well as in the general population secondary to
malocclusions and dental deviations (with a range of severity), as
described next.
Dental deviations are deviations in specific teeth. The term dental
deviations refers only to deviations in the position or alignment of specific
teeth or to the absence of one or more teeth. These deviations are
distinguished from malocclusions (or occlusal deviations), which are
abnormalities in how the upper (maxillary) and lower (mandibular)
dental arches occlude or meet with one another. Dental deviations
include missing, rotated, ectopic (in the wrong place), supernumerary
(extra) and anomalous (atypical form), labioverted, and linguaverted
teeth. Occlusion is based on the positional relationship between the
maxillary and mandibular first molar teeth. Malocclusion can disturb
the ideal anterior-posterior relationship between the dental arches
resulting in overjet (Angle class II malocclusion) or underbite (Angle class
III malocclusion). Remembering that the tongue is housed in the
mandible, articulatory consequences of these malocclusions are
predictable. Other forms of malocclusion include crossbite and open
bite. Malocclusion can secondarily affect the anterior-posterior and
vertical relationships between upper and lower lips and thus interfere
with normal bilabial and labiodental articulations. The effects of dental
and occlusal deviations on speech articulation are addressed in
Chapters 7 and 8.
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