Articulation Disorders

A) Dyslalia / MIS Pronunciation

What Sounds Sweet At 3
Turns Sour At 5

Articulation Disorders essentially involve Omissions, Substitutions, Additions & Distortions.

Eg. Probly for probably, recognize for recognize.

Eg. Dem for them, git for get.

Eg. Acrosst for across, fillum for film.

Eg. Varies

Steps For Correction Of Abnormal Speech>
First step in correction - child's awareness & acceptance of his errors & diction. Speaking well is a social advantage.


  1. Pampering.
    (a) Lack of stimulation (Deprivation)
  2. Structural
    (a) Malocclusion eg- Overbite
    (b) Tongue tie
    (c) Cleft lip and Palate (CL+P)
  3. Tongue Tie

  4. Sensory Impairment
    (a) Hearing loss
  5. Neurologenic
    (a) Cerebral Palsy (CP)

Age Range
Generally younger people (Below the age of 15 years).

Good with regular follow up in normal cases. In case of Cleft lip and palate lot depends on the time, type and success of the surgery. In case of CP condition can be maintained but not completely cured.

Offers total play way method for these children. Providing them with relaxed atmosphere in which they can explore at their will and expand not only through therapy, but also by way of self exploration and experience. Lot of their Pre skills develop with our holistic approach. These preskills are required for learning language in the form of reading, writing, spellings and reasoning skills (for preskills, kindly refer to LD section). We are proud to have given cent percent results in this area in past, in normal cases.

B) Cleft Lip & Palate Deformity

What Is CL+P ? And What Are Its Causes?
Cleft lip and palate is a congenital deformity arising either due to "Excessive gene carrier", or due to environmental (intra-uterine) factors.

Associated Problems
Amongst the Congenital deformity, this is one of the most common factor, which leads to communicative disorders. CL + P undergoes feeding problems, speech and voice disorders, dental deviations, mid-facial growth problems middle ear pathologies, along with hearing disorders, social adjustment difficulties and malmaturation of intellectual abilities.

Parental Suffering
Parents of such children undergo a lot of psychological trauma, physical trauma and social trauma.

General Classification Of CL+ P

The three main types of CL+ P are
  1. Unilateral cleft lip and palate
  2. Bilateral cleft lip and palate
  3. Cleft of palate only
The extent of cleft can vary antero-posteriorly from cleft of lip + alveolar ridge + hard palate + soft palate, to cleft of only the soft palate.

Sub-Mucous Cleft
This is the condition where the outer mucosal membrane is intact, but the in-between layer of muscles of the soft palate has a cleft. It is difficult to diagnose this condition and some times goes unnoticed till adulthood. Generally this child will have hypo-nasal voice. PN: Many a times CL + condition is associated with various syndromes, mental retardation, sensory neural hearing loss etc.

Eval & Assessment
As a speech and language pathologist cum audiologist, it is advisable to give the following assessment procedures for a CL + P cases.

  1. CaseHistory-with special mention of time and type of surgery birth order family H/O CL + P
  2. Recording
  3. Pure tone audiogram or BSERA (BERA) and Impedence audiogram.
  4. Voice analysis - Nasometry either on Visipitch or VAGHMI Software.
  5. Articulation assessment
  6. Phonological assessment (which indicates presence or absence of compensatory articulatory pattern.
  7. Language assessment - by giving age appropriate language assessment test.
  8. Spectrographic analysis - Optional
  9. Soft tissue Palatography - For your interest.
Eval & Referrals
  1. Parents are advised to visit
  2. E.N.T. check-up after the audiometric testing.
  3. Prosthodontist & Orthodontist - dental check-up, as these cases invariably have mild to severe dental alignment problems.
  4. Psychometric testing if required.
  5. Genetic Counseling
  6. Plastic surgeon. It is important to follow-up the case till the patient reaches adulthood. Yearly, assessment by above referrals is most ideal. Once, the measurement is through, the therapist begins his/her management mainly for the correction of speech sounds, restoring normal resonance, corrections of compensatory articulatory patterns and language stimulation (if necessary).
Age Range
Since birth.

Early intervention is must for better results. Speech Therapy should start as early as 6 weeks after the surgery,i.e. around the age of 18-20 months. Better results can be achieved if the surgery is successful in obtaining total Velopharyngeal Closure. Continuing therapy on regular basis for long time is required to overcome compensatory articulatory techniques.

Services Offered At 'nirmitee'
At 'nirmitee' we are equipped to carry out first 7 assessments from above. Keeping the need for long-term follow-up in mind, Home programmes could be given formulated by researchers at 'Nirmitee' as and when suggestive.

Special Care At 'nirmitee', we are extremely concerned and care for the results. Hence, we consider it as our duty to keep in touch with the Plastic Surgeon, ENT, Counselor, Dentist and the entire team looking after your child / CL+P patient.

C) Dysarthria

What Is Dysarthrias?
It is a motor speech disorder arising out of Neuropatholgy. It exhibits disturbed pattern of speech due to weakness, slowness and in-coordination of speech muscles.

Associated problem is comprehension and use of the language.

The person's performance remains same with repeated utterence.unlike in case of apraxia. Dysarthric will show deterioration of performance with increased rate of speech. They happen to have more errors in the final position.. Their sucking and chewing functions are disturbed.

Age Range
All age groups. - Associated with Cerebral Palsy since birth. And neuromuscular disorders generally seen in an elder age group, above the age of 65 years.

  1. Neoplasm
    Tumours in brain and Nervous System
  2. Congenital
    Cerebral Palsy
  3. Injury and trauma
    Brain and Nervous System
  4. Neurological and Nueromuscular Disorders
    Multiple sclerosis, Parkinson's Disease, Mysthenia Gravis, bulbar palsy, and acccidents etc
  5. Stroke
Depending on the severity of the problem and the under lying condition dysarthria can be treated well enough to achieve near normalcy and maintain the speech at that level if followed regularly with a Speech therapist.

At 'nirmitee', we offer unique treatment for Dysarthric patients, involving yoga, pranayama and nadishodhana, apart from the conventional Speech therapy. The flexibility of the timings aided with relaxed environment and ample space make our patients cheery and happy to want to come again and again.Our therapists do the complete evaluation and assessment of cases with dysarthria along with case history. Patients with family members are counseled thoroughly regarding the nature of the problem, the differential diagnosis, treatment program and prognosis of the disorder.

D) Dyspraxia / Apraxia

What Is Apraxia?
It is a motor speech disorder with articulation errors in absence of muscle slowness, weakness or in-coordination. There is a disruption of Cortical programming for voluntary production and sequencing of speech sounds.

The child's/adult's speech sounds garbled even though there is no muscular paralysis. He may not know what to do with his lips and tongue. This is the disorder of volitional movement patterns. The person appears to grope or struggle with repeated utterance. Associated problem is comprehension and use of the language. Very often Problem of Aparaxia is mis-judged as a problem of Dyslexia.

Neurogenic in nature, in absence of any disabling condition of the oral organs.

Age Range
All age groups. Very often overlap with Learning Difficulty.

Good,if mild in nature with lots of exercises on regular basis. At 'nirmitee', we have always got good results with cases having Dyspraxia, when looked after on regular basis. We expertize in differciating diagonis of Dyspraxia V/s Aparaxia.

E) Cerebral Palsied Speech

What Is Cerebral Palsy?
A group of disorders due to brain injury in which the motor coordination are especially affected. They exhibit articulation disorder as seen in case of Dysarthria. Also they suffer from Swallowing Disorder -- Dysphagia

  1. Brain injury at birth
  2. Asphyxia
  3. Prematurity
  4. Prolonged labor
  5. Rubella
Types Of Cerebral Palsy
  1. Spastic
  2. Athetosis
  3. Ataxic
  4. Mixed

Age Range
Since birth.

Depends on severity and type of C.P. and associated problems. As has been our experience cure is not something that goes along with the lable 'C.P.' In mild cases near normal speech and language could be very much the aim of the therapist. At 'nirmitee' we provide speech and language development through play way and integrated efforts by Occupational Therapist and Speech therapist.

Sensory Integration, Bobath therapy, CSR & PNR approaches are used to treat these patients.

F) Dysphagia

What Is Dysphagia?
Dysphagia is a swallowing disorder, when someone experiences a difficulty in swallowing. Dysphagia is seen from childhood to old age. Some people are aware of their problem, however quite often some are not. Very often, these patients choose food that can be eaten and swallowed easily.

Types Of Dysphagia
  1. Unsafe Swallow
    Food or saliva enters the windpipe
  2. Slow Swallow
    It is difficult to take enough food or liquid for nutrition
Causes Of Dysphagia
  1. Neurological and Neuro Muscular
    Stroke (Paralysis), Parkinson's disease, Alzheimer's disease, Myasthenia Gravis, Muscular Dystrophies, Cerebral Palsy, Pospolio
  2. Syndrome Cancer
    Upper respiratory tract cancer, Chemotherapy drugs Head and Neck Injury
  3. Congenital
    Cerebral Palsy
  4. Environmental Medication:
    Anti-depressants, Neuroleptics, Anti-biotics, Cardiac Drugs

Consequences Of Dysphagia
The consequences of Dysphagia range from discomfort like chest pain embarrassment from coughing choking life-threatening illnesses (Eg: Silent aspiration, aspiration pneumonia) Note that aspiration is not always apparent. Most often Dysphagia Is associated with Articulation Disorders - (Dyslalia). Which can be cured side by side.

Age Group
The age range includes all age groups but usually risk increases with age.

Depending upon the type of associated neurological problem, prognosis varies from good to poor

How Can We Help You With Dysphagia?
At 'nirmitee' Integrated Rehabilitation Centre, we believe complete understanding and accepting of a problem is half-way through the solution. We counsel patients as well as family members regarding Dysphagia. An understanding of this swallowing problem and tackling it. After taking a complete medical history and clinical examinations of neuro-muscular functions, we suggest the kind of diet, with weightage on the consistency of food. Moreover, exercises to enhance swallowing or develop normal swallowing are given as therapeutic treatment for Dysphagia patients.

Cannot visit our clinic? No problem! We also dispense home programmes that can be carried out at your convenience of time and place. A home visit is possible within 1km area of our Clinic.