What is Arthritis Disorder
Η joint disorder is a developmental disorder in which a person has difficulty producing specific speech sounds, resulting in speech that is less understandable.
In other words, it is the difficulty that children, especially children, have in pronounce certain sounds correctly when they talk. They may, for example, say “tala” instead of “ladder” or “pelo” instead of “hat”.
It doesn't mean there is a problem with their intelligence - it just means they need support the way they use their mouth, tongue and lips to make sounds.
According to the International Classification of Diseases (ICD-10), this disorder is classified as F80.0 - Specific joint disorder. The child uses phonemes at a lower level than that of his/her cognitive age, while his/her language skills are at a normal level.
That is, the child uses correct syntax, has an age-appropriate vocabulary but does not speak “clearly”.
In addition, other forms include the dysarthria, which is associated with neurological disorders and verbal dyspraxia, due to difficulties in the coordination of the muscles of the mouth.
Another related disorder is the phonological disorder, which differs from the joint disorder.
In this case, the child (or person) does not use the sounds of language correctly, not because he or she cannot pronounce them, but because he or she does not know how to put them in the right place in words.
This disorder can make it difficult for others to understand speech and can affect speech comprehension in general. communication of the child, and often requires specialised speech and language therapy intervention.
Causes and Risk Factors
The joint disorders and phonological disorders can be caused by a number of factors. Most often they are due to development factors, such as speech delay or speech impediment, or specific language disorder.
A child who has a speech delay is likely to have a delay in acquiring correct phonemic articulation, in line with expected developmental milestones. However, this is not an absolute.
The neurological factors may be another cause. For example, cerebral palsy can affect the child's ability to use the sounds of language correctly and cause dysarthria.
Many children with anatomical or organic issues have concomitant joint disorders.
For example, prognathism or poor convergence of the teeth can affect the production of the sibilant sounds, i.e. “s“ or "z".
Many times, the joint is also affected by external factors. Prolonged use of a bottle or pacifier or thumb dislocation can significantly affect the anatomy of the mouth, resulting in incorrect articulation.
A cleft palate or cleft lip can affect a group of sounds - phonemes.
Finally, partial deafness can also affect the correct placement of sounds. It is typical that children who suffer from frequent ear infections, during the age of acquiring a sound, end up distorting it, because essentially when they had to learn it they were not hearing it correctly.
The genetic factors can also affect correct articulation, as some children who have difficulties with articulation usually have parents who also had similar difficulties.
Common Forms of Joint Disorders
As mentioned above, many children have difficulty producing certain sounds correctly.
The most common phonemes that are altered are syringes (e.g.s,z and their clusters i.e. “f, pσ, πσ, κσ, τζ etc.), the dental (e.g. d, i and their clusters, i.e. “dr, θr, χθ, ρθ etc.) and the lipodontics (e.g. φ, β and their clusters, i.e. “Φρ, φτ, βρ, βγ” etc.).
However, this does not mean that these are the only sounds that can be altered.
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Articulation disorder in “s” and other phonemes:
The most common articulation disorder involving the “s” sound is called sigmatism. There are different types of sigmatism, for example:
- Mid-tooth sigmatism: air passes between the teeth, resulting in the “s” sounding distorted. What some parents typically say is that the child “whistles it”.
- Lateral sigmatism: Air escapes from the sides of the tongue instead of the centre, resulting in a distorted, wet “s” (like a child holding saliva in the mouth) or “h”.
- Transdental Sigmatism: The tongue is placed between the teeth and sounds like an “i”.
- Nasal sigmatism: air escapes from the nose and the sound sounds like a soft “snoring”.
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Articulation disorder in other phonemes:
Another common difficulty is the production of the “r”, the so-called “rotacism”.
The phoneme “ρ” is characterized by the intense vibration of the tongue and the accompanying airflow and requires delicate and well-coordinated muscle manipulations.
Often there is a complete substitution of the sound with another sound, e.g. “luda instead of rose”.
There are children who have mastered the correct placement but without the vibration during the production of the phoneme.
This results in the production of ‘r’ in a more “French” way, i.e. it sounds more like a “c”.
Joint disorder in adults
The joint disorder in adults occurs either as a continuation of a developmental difficulty from childhood, or because of trauma or neurological disease, such as stroke or Parkinson's.
It can affect the clarity of speech, making communication more difficult.
This difficulty is usually related to correct tongue positioning, muscle strength and breath control.
With the help of speech therapy, adults can enhance their speech and significantly improve their everyday communication.
Diagnosis and Evaluation
Each correct Evaluation starts with a complete medical and developmental history.
In many cases we need to ask the child himself for some information that the parents may not be able to give us, e.g. whether he understands his difficulty, how he feels, whether he has been made fun of, whether he needs to think of other words when others do not understand, etc.
Once the history has been taken, we move on to procedures to evaluate the child himself.
Initially, one joint test. It is important to mention that each speech and language therapist can use their own test, the results of which, although indicative, are not official.
The only official test for the evaluation of the phonological system of Greek-speaking children that has been adapted and weighted to Greek data is the “Test of Phonetics and Phonological Development”, of Panhellenic Association of Speech and Language Therapists (1995).
Then it is carried out η orofacial examination, which is designed to detect functional or structural difficulties in articulators.
The test evaluates the strength, accuracy and range of motion of the articulated organs, such as the tongue, lips, palate and lower jaw.
This process involves simple commands or activities in which the child is asked to perform specific movements. The speech therapist observes the speed, symmetry and coordination of movements in order to identify any malfunctions.
In addition, breathing, nasal expiration, phonation function and even swallowing are evaluated, as all of these are closely related to speech production.
The results of the orofacial examination, in combination with the speech evaluation, provide the speech and language therapist with a clear picture of the
the needs of the child and guide the Design the appropriate treatment.
Intervention required:
When speech is unintelligible to the environment: if at the age of 4-5 years the child's speech is not understood by people outside the family, this is an indication for possible intervention.
When the acquisition of basic phonemes is significantly delayed: each phoneme has a developmental age limit within which it is expected to be mastered.
According to the Panhellenic Association of Speech and Language Pathologists, the ages of vocalization are as follows:
| AGE | VOICE |
| 2,6 - 3 years old | m, p, t, t, k, b, g |
| 3 - 3.6 years old | n, b, c, h, d |
| 3,6 - 4 years old | f, s, g, z, l, l, σπ, pl, kl, kl, kn, pn, px, ng |
| 4 - 4.6 years old | i, d, fl, f, fx, ps, x, xt, tr, kr, gd, zm, mn |
| 4,6 - 5 years old | sf, br, dr, hn, zg, ft, ch, nj |
| 5 - 5.6 years old | GLE, GG, GTR |
| 5,6 - 6 years old | r, d, dr, th, htr |
When errors in articulation are constant and repetitive: i.e., a consistent pattern of substitution or omission of sounds
and these are not occasional or random mistakes.
When there are organic, neurological or anatomical causes: in cases such as cerebral palsy, clefts, syndromes, trauma or low muscle tone, speech therapy intervention is necessary and usually long-term.
Treatment and Exercises for Arthritis Disorder
Η treatment of the joint disorder is based on the speech and language therapy intervention, aiming at the correct production of the sounds that make it difficult for the child.
Ο speech and language therapist applies exercises, targeting specific phonemes, through repetition, auditory, visual and motor stimuli. Η treatment is personalised and develops gradually, depending on the needs of each child.
Initially, it aims to strengthen the orofacial muscles. Then the placement of the target phoneme. Then to practice through words containing it, first in the initial position, then in the middle and then in the final position.
Finally, it seeks generalisation and automatisation through sentences, short texts and spontaneous dialogue.
An important role is played by the parental involvement at home. Exercises in front of a mirror help the child to observe the movement of the lips and tongue. In addition, word games and daily repetitions reinforce correct articulation in a fun way.
Finally, technological aids such as special applications and visual stimuli (e.g. pictures, videos with speech) support progress by enhancing imitation and auditory discrimination of sounds.
Η systematic practice and the proper guidance by the specialist are crucial elements for the rehabilitation of the disorder.
