Clinical Linguistics Louise Cummings The Royal College of Speech and Language Therapists estimates that 2.5 million people in the UK have a communication disorder. Of this number, some 800,000 people have a disorder that is so severe that it is hard for anyone outside their immediate families to understand them. In Clinical Linguistics, Louise Cummings examines the various developmental and acquired communication disorders that constitute these large and growing figures. In chapters that are dedicated to the discussion of individual communication disorders, Cummings argues that no treatment of this area can reasonably neglect an examination of the prevalence and causes of communication disorders.The assessment and treatment of these disorders by speech and language therapists are discussed at length.This book contains up-to-date research into communication disorders and describes the various technological innovations that are integral to the work of speech and language therapists. Clinical Linguistics is appropriate reading for students, practitioners and researchers in speech-language pathology and related clinical and academic disciplines. It contains the following chapters:The Scope of Clinical Linguistics; Disorders of the Pre- and Perinatal Period; Disorders of Cognitive Development; Disorders of Speech and Language Development;Acquired Communication and Swallowing Disorders; Disorders of Fluency; Disor ders of V oice. Louise Cummings is a Reader in Linguistics, Nottingham Trent University. She is a member of the Ro yal College of Speech and Language Therapists and is registered with the Health Professions Council. ‘ Clinical Linguistics by Louise Cummings is a monumental undertaking. Cummings covers the discipline, from child language and speech disorders to failed communication in adulthood. Further, she covers each of the disorders comprehensively, from its biology and its medical features to its epidemiology; from assessment to treatment. And it is all done with a sound and disciplined scholarship.This almost encyclopedic text is even-handed and fair, focusing on the disorders and the individuals who have them, rather than on professional opinions concerning effective treatment. It is truly breathtaking, in scope and in consistency of purpose. I really can't think of anything like it.’ Audrey L. Holland, Regents’ Professor Emerita, University of Arizona. Cover design: www.riverdesign.co.uk Cover image: Magnetic resonance 2 © iStockphoto, 2007 Edinburgh Univ ersity Pr ess 22 George Square, Edinburgh EH8 9LF www.eup.ed.ac.uk ISBN 978 0 7486 2077 7 Louise Cummings Edinburgh barcode Louise Cummings Clinical Linguistics Clinical Linguistics Clinical Linguistics In memory of a dear friend Jacqueline Elizabeth Henry (née McCormick) 23.3.1971 ~ 24.1.2001 Clinical Linguistics Louise Cummings EDINBURGH UNIVERSITY PRESS © Louise Cummings, 2008 Edinburgh University Press Ltd 22 George Square, Edinburgh Typeset in 11/13 Ehrhardt MT and Gill Sans by Servis Filmsetting Ltd, Manchester, and printed and bound in Great Britain by Antony Rowe Ltd, Chippenham, Wilts A CIP record for this book is available from the British Library ISBN 978 0 7486 2076 0 (hardback) ISBN 978 0 7486 2077 7 (paperback) The right of Louise Cummings to be identified as author of this work has been asserted in accordance with the Copyright, Designs and Patents Act 1988. Contents List of Figures and Tables ix Acknowledgements xi Preface xiii 1 THE SCOPE OF CLINICAL LINGUISTICS 1 1.1 A New Definition of an Established Practice 1 1.2 Human Communication: Processes 2 1.3 Human Communication: Disorders 4 1.4 The Contribution of Linguistic Science 7 1.5 The Contribution of Medical Science and its Practitioners 12 1.6 The Purpose of Structure 17 1.6.1 Epidemiology and Aetiology 18 1.6.2 Clinical Assessment 19 1.6.3 Clinical Intervention 21 Notes 23 2 DISORDERS OF THE PRE- AND PERINATAL PERIOD 27 2.1 Introduction 27 2.2 Cleft Lip and Palate 28 2.2.1 Epidemiology and Aetiology 28 2.2.2 Clinical Assessment 38 2.2.2.1 Feeding 39 2.2.2.2 Speech 41 2.2.2.3 Hearing 50 2.2.2.4 Language 55 2.2.3 Clinical Intervention 60 v 2.2.3.1 Surgical Intervention 60 2.2.3.2 Speech and Language Intervention 63 2.3 Cerebral Palsy 70 2.3.1 Epidemiology and Aetiology 71 2.3.2 Clinical Assessment 75 2.3.2.1 Feeding 76 2.3.2.2 Speech 81 2.3.2.3 Hearing 87 2.3.2.4 Language 89 2.3.3 Clinical Intervention 92 2.3.3.1 Feeding Intervention 93 2.3.3.2 Communication Intervention 99 Notes 110 3 DISORDERS OF COGNITIVE DEVELOPMENT 129 3.1 Introduction 129 3.2 Learning Disability 130 3.2.1 Epidemiology and Aetiology 131 3.2.2 Clinical Presentation 138 3.2.2.1 Feeding 138 3.2.2.2 Speech 141 3.2.2.3 Hearing 149 3.2.2.4 Language 152 3.2.3 Clinical Intervention 160 3.2.3.1 Early Communication Intervention 161 3.2.3.2 Speech and Language Intervention 165 3.2.3.3 Augmentative and Alternative Communication 177 3.3 Autistic Spectrum Disorder 182 3.3.1 Epidemiology and Aetiology 186 3.3.2 Clinical Presentation 192 3.3.2.1 Comorbid Conditions 193 3.3.2.2 Communication Features 197 3.3.3 Clinical Assessment 204 3.3.4 Clinical Intervention 209 Notes 219 4 DISORDERS OF SPEECH AND LANGUAGE DEVELOPMENT 244 4.1 Introduction 244 4.2 Developmental Verbal Dyspraxia 245 4.2.1 Epidemiology and Aetiology 245 CONTENTS vi 4.2.2 Clinical Presentation 247 4.2.3 Assessment and Diagnosis 254 4.2.4 Clinical Intervention 259 4.3 Developmental Phonological Disorder 265 4.3.1 Epidemiology and Aetiology 265 4.3.2 Clinical Presentation 267 4.3.3 Phonological Assessment 271 4.3.4 Phonological Intervention 276 4.4 Specific Language Impairment 281 4.4.1 Epidemiology and Aetiology 282 4.4.2 Clinical Presentation 285 4.4.3 Clinical Intervention 293 4.4.4 SLI and Cognitive Deficits 297 4.5 Landau-Kleffner Syndrome 299 Notes 302 5ACQUIRED COMMUNICATION AND SWALLOWING DISORDERS 310 5.1 Introduction 310 5.2 Acquired Dysarthria 310 5.2.1 Epidemiology and Aetiology 311 5.2.2 Clinical Presentation 317 5.2.3 Dysarthria Assessment 321 5.2.4 Dysarthria Intervention 327 5.3 Apraxia of Speech 331 5.3.1 Epidemiology and Aetiology 331 5.3.2 Clinical Presentation 332 5.3.3 Assessment and Intervention 335 5.4 Acquired Aphasia 341 5.4.1 Epidemiology and Aetiology 342 5.4.2 Clinical Presentation 344 5.4.3 Aphasia Assessment 349 5.4.4 Aphasia Intervention 353 5.5 Acquired Dysphagia 357 5.5.1 Epidemiology and Aetiology 357 5.5.2 Clinical Presentation 358 5.5.3 Dysphagia Assessment 358 5.5.4 Dysphagia Intervention 361 5.6 Schizophrenia 364 Notes 370 CONTENTS vii 6 DISORDERS OF FLUENCY 378 6.1 Introduction 378 6.2 Stuttering 379 6.2.1 Epidemiology and Aetiology 379 6.2.2 Clinical Presentation 381 6.2.3 Clinical Assessment 385 6.2.4 Clinical Intervention 389 6.3 Cluttering 397 Notes 400 7 DISORDERS OF VOICE 404 7.1 Introduction 404 7.2 Voice Disorders 405 7.2.1 Epidemiology and Aetiology 405 7.2.2 Clinical Presentation 410 7.2.3 Clinical Assessment 411 7.2.4 Clinical Intervention 413 7.2.4.1 Surgery 414 7.2.4.2 Radiotherapy 416 7.2.4.3 Drugs 416 7.2.4.4 Voice Therapy 417 Notes 420 Bibliography 423 Index 498 CONTENTS viii List of Figures and Tables Figures 1.1 The process of communication 4 2.1(A) Frontal view of mouse embryo on day 10 of gestation 30 2.1(B) Fifth week of human gestation 30 2.1(C) Frontal view of mouse embryo on day 11 of gestation 31 2.1(D) Frontal view of human embryo 31 2.1(E) Human embryo during sixth week of gestation 32 2.1(F) A mouse embryo on day 11 of gestation 32 2.1(G) A mouse embryo on day 12 of gestation 33 2.2 The normal lip and nose 34 2.3(A) Frontal view of a mouse embryo on day 14 of gestation 34 2.3(B) Frontal view of a mouse embryo on day 14 of gestation 35 2.3(C) Human embryo in the ninth week of gestation 35 2.4 The normal and cleft palate 36 2.5 The cleft lip and nose 37 2.6 Unilateral and bilateral cleft lip and palate 37 2.7 Primary teeth 39 2.8 Gross structure of the ear 51 2.9 Opening of the Eustachian tube 52 2.10 Ventilating tube in the ear drum 53 3.1 Pictographic and ideographic Blissymbols 178 3.2 Picture Communication Symbols 180 7.1 Anatomical structures after laryngectomy and postlaryngectomy voice production 415 ix [...]... contribute to the knowledge base of these individuals as well xiv 1 The Scope of Clinical Linguistics 1.1 A New Definition of an Established Practice In this book, I want to give new prominence to the somewhat neglected expression clinical linguistics I say ‘expression’ rather than ‘field of study’ because, of course, clinical linguistics has been a thriving area of enquiry amongst researchers and practitioners... speech and language therapy for many years now.1 However, while the practice of clinical linguistics in academic and clinical contexts has expanded considerably, the term clinical linguistics has lost out to competitor expressions, such as clinical communication studies’ Although the reasons for this shift towards these other expressions are clear enough – for example, the need to have a broader term... the full range of disorders that are encountered by clinicians – I believe the term clinical linguistics gives due emphasis to the role of language in communication and highlights the essentially scientific character of linguistics itself In this book, I adopt the following definition of clinical linguistics: Clinical linguistics is the study of the numerous ways in which the unique human capacity for... all the disorders that are encountered by speech and language therapists2 across a range of clinical contexts This definition emphasises the fact that when we are studying clinical linguistics, we are engaging not simply with an academic discipline, but also 1 THE SCOPE OF CLINICAL LINGUISTICS with an area of clinical practice By placing language at the centre of the above definition, I am seeking to... nature of clinical linguistics, and the diverse professional roles and collaborations into which speech and language therapists must enter in different clinical contexts 1.6 The Purpose of Structure In the remaining chapters of this book, I base my examination of communication disorders on the following three-part structure: (1) epidemiology and aetiology, (2) clinical assessment and (3) clinical intervention... emphasise the place of practice in clinical linguistics, to re-establish the foundational role of language in all human communication and to recognise the important, but frequently overlooked, work on feeding and swallowing disorders in speech and language therapy In its consideration of all three of these features, this definition moves beyond previous accounts of clinical linguistics. 3 Yet, in doing so,... integration of lexicology with clinical linguistics will make it possible to articulate more explicitly the nature of this predictive relationship Third, with the lexicon playing a central role in recent cognitive neuropsychological explanations of disorders such as aphasia and dyslexia, it seems only reasonable that we should attempt to integrate lexicology more closely with clinical linguistics Having established... intellectual history, pragmatics has included 11 THE SCOPE OF CLINICAL LINGUISTICS the study of diverse phenomena, not all of which have exhibited conceptual coherence It is hardly surprising, therefore, that many clinical investigations of pragmatics have lacked both focus and rationale (see chapter 9 in Cummings 2005) More recently, however, clinical studies of pragmatics have been reshaping our views... phonetic fonts and Sarah Edwards of Edinburgh University Press, for accommodating my numerous requests as the book developed The assistance of each of these individuals and organisations has been invaluable Much of the research for this book was undertaken while I was a Visiting Fellow in the Centre for Research in the Arts, Social Sciences and Humanities (CRASSH) at the University of Cambridge I am grateful... has been largely overlooked by clinical linguists This neglect is understandable in part; by and large, academic linguists have tended to pursue historical treatments of lexicology, which are of limited relevance to the clinician who must assess and treat language and communication disorders Yet, there are clear reasons why greater integration of lexicology with clinical linguistics should be encouraged . McCormick) 23.3.1971 ~ 24.1.2001 Clinical Linguistics Louise Cummings EDINBURGH UNIVERSITY PRESS © Louise Cummings, 2008 Edinburgh University Press Ltd 22 George Square, Edinburgh Typeset in 11/13 Ehrhardt. Cummings Edinburgh barcode Louise Cummings Clinical Linguistics Clinical Linguistics Clinical Linguistics In memory of a dear friend Jacqueline Elizabeth Henry (née McCormick) 23.3.1971 ~ 24.1.2001 Clinical. of Clinical Linguistics 1.1 A New Definition of an Established Practice In this book, I want to give new prominence to the somewhat neglected expres- sion clinical linguistics . I say ‘expression’