Articulation Disorders Research Articles

A novel MAOA gene variant: Brunner syndrome, a rare syndrome, is associated with a wide range of psychiatric symptoms.

Brunner syndrome is a rare genetic disorder that associated with mutations in the MAOA gene. It has been linked to a number of psychiatric disorders. We present detailed information on psychiatric evaluation of a case carrying a novel MAOA gene variant of p.(Thr408Met). The patient was referred to our clinic with a history of attention problems, motor coordination difficulties and a tendency to bite objects. Following a comprehensive psychiatric evaluation, the patient was diagnosed with developmental coordination disorder, articulation disorder and attention deficit hyperactivity disorder (ADHD). MAOA mutations are rarely reported in the literature. To date, a total of 23 MAOA gene variants, mostly missense variants, have been reported through the HGMD database (Professional 2023.4). Neurodevelopmental symptoms may vary in severity and diversity among patients with Brunner syndrome. Different degrees of intellectual disability have been found in previously reviewed cohorts of Brunner syndrome. In our affected patient, cognitive development and academic achievement were at a similar level to his peers. Additionally, our patient exhibited symptoms suggestive of developmental coordination disorder. Our findings show that genetic mutations in MAOA can lead to a wide range of clinical symptoms and underline the need for comprehensive genetic and clinical evaluations.

Transforming lives in autism spectrum disorder treatment through acupuncture: A case report

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication, restricted and repetitive behaviors, and narrow interests. Given the high prevalence of ASD and the lack of specific pharmacological treatments, there is a pressing need for alternative therapeutic approaches. Acupuncture has shown promise in improving the clinical symptoms of ASD. This report presents the case of a 6-year-old girl diagnosed with ASD, intellectual developmental disorder, attention deficit hyperactivity disorder, and articulation disorder. She underwent Liu’s pediatric neurological rehabilitation acupuncture therapy (PNRAT) for over 2 years. The treatment involved specific scalp acupuncture techniques targeting cognitive and linguistic rehabilitation. After the treatment course, the patient showed significant improvements in cognitive, linguistic, social, and behavioral symptoms, transitioning from limited verbal communication and marked social difficulties to thriving in a mainstream school setting. This case highlights the potential of Liu’s PNRAT as an effective intervention for ASD. The observed improvements suggest that acupuncture may offer valuable therapeutic benefits for children with ASD, contributing to the growing interest in its potential as an adjunct therapy. Further research is needed to optimize treatment protocols and explore synergies with conventional therapies.

Hearing, speech, and language outcomes in school-aged children after cleft palate repair.

Following primary cleft palate repair, individuals face a heightened risk of hearing problems, particularly conductive hearing loss, compensatory articulation disorders (CADs), resonance disorders, delayed speech and language development, and voice disorders. This study aimed to investigate the prevalence and impact of these challenges in children with cleft palate with or without cleft lip (CP± L). This cross-sectional study included 38 children with CP± L aged 5 to 13 years. A comprehensive evaluation involved audiological assessments (audiograms, tympanograms) by an audiologist and speech-language pathology assessments (Thai Speech Parameters for Patients with Cleft Palate, Articulation Screening Test) by speech-language pathologists. The prevalence of hearing loss affected 27.63% of participants (21 out of 76 ears) and majority of cases involved conductive hearing loss. Velar substitution was the most common CAD, followed by nasalized voiced pressure consonants, phoneme-specific nasal air emission, and pharyngeal substitution. A moderate correlation was found between these CAD patterns and hypernasality at the word, sentence, and screening levels (r= 0.44, p< 0.01; r= 0.43, p< 0.01; and r= 0.40, p= 0.01). For summary, the most common type of hearing loss was conductive hearing loss. The predominant CAD pattern was velar substitution. The protocol could be designed to enhance early improvement in hearing and articulation, thereby supporting academic achievement and long-term quality of life.

Occlusal therapy in patients with temporomandibular joint dysfunction and occlusal and articulatory disorders

the article presents a statistical analysis of the assessment of the impact of various factors that led to occlusal and articulatory disorders and functional disorders of the masticatory apparatus on the choice of occlusal constructions therapy for the treatment of temporomandibular joint dysfunction. For conducting the research, a clinical and laboratory examination was carried out and orthopedic treatment of 150 patients with various occlusal options violations Variants of occlusion therapy are described and given characteristic.

"The Decision to End Speech Therapy Brought More Peace and Tranquility Into Our Family": Exploring Speech-Related Treatment Fatigue and Dropout in Parents and Children With a Cleft Palate.

Treatment fatigue is a complex, multidimensional, multicausal, and subjective phenomenon that is not yet well explored and understood in the area of speech therapy. The purpose of this study was to investigate speech-related treatment fatigue and speech treatment dropout in parents and children with a cleft (lip and) palate receiving or having received speech treatment for cleft-related articulation disorders. Thirteen participants were included in this study (n = seven parents with a median age of 40 years and n = six children with a median age of 10 years). Qualitative semistructured interviews were conducted separately with parents and children to investigate their experiences with cleft speech treatment. An inductive thematic approach was used to analyze the data and construct different themes. Rigor of the data was verified by conducting an investigator triangulation and by performing member checks. The analyses of the interviews yielded three major themes of importance to the children and their parents: (a) physical symptoms of treatment fatigue, (b) psychological symptoms of treatment fatigue, and (c) from treatment fatigue to treatment dropout. Physical symptoms of treatment fatigue were mainly related to transportation burden. On a psychological level, speech treatment may potentially lead to a cognitive-emotional overload. These feelings are primarily related to the practical issue of scheduling required treatment sessions in the family agenda. The decision to discontinue speech treatment was reported to be multifactorial. In this decision-making process, data suggested that the child's perspective must be heard more.

An exploration of UK speech and language therapists' treatment and management of functional communication disorders: A mixed-methods online survey.

Functional Communication Disorders (FCDs) are one specific presentation of Functional Neurological Disorder (FND). FND is characterised by neurological symptoms, such as sensory and motor symptoms, which are not explained by neurological disease. Speech and language therapists (SLTs) have expertise in managing communication disorders, including FCDs, though is not known is what clinicians do in practice to treat and manage FCDs. To explore the clinical practices of SLTs who regularly manage FCDs in the UK, including the assessment and intervention approaches taken. An online survey was developed using Qualtrics software and piloted before dissemination. Participants were experienced SLTs working in the UK who managed at least three FCD referrals a year. The survey was developed with a mix of qualitative and quantitative questions. The survey was disseminated via social media and professional networks. There were 73 completed responses to the survey. Participants reported working with a range of FCDs clinically, with functional stuttering and articulation disorders seen most frequently. SLTs reported working with a wide range of multidisciplinary professionals when managing patients with FCDs, though lack of access to mental health professionals was raised as an issue. SLTs reported using a combination of formal and informal communication assessments. Interventions varied, with a wide range of psychological approaches informing treatment. Lack of specific training, evidence base and negative attitudes around functional neurological disorder (FND) were raised as ongoing issues. Therapists encountered a wide range of FCDs as part of their clinical practice, though there was a significant disparity in the service and interventions offered. SLTs feel their input can be effective, but lack the resources, training and evidence-based interventions to provide adequate care. What is already known on the subject FCDs are one manifestation of FND and can present as a wide range of communication disorders. SLTs encounter FCDs as part of clinical practice, but report feeling unsure and underprepared to manage these disorders. Consensus recommendations have provided some guidance on how to manage these disorders, though what was not known was what practising SLTs are doing in practice with FCD patients: what assessment, intervention and management strategies they use, and what they feel are the facilitators and barriers to effective management. What this study adds to the existing knowledge This is the first UK-wide survey of FCD SLT clinical practice. The survey found that SLTs are seeing a range of FCDs as part of their clinical practice. SLTs reported that they feel their input is effective, that they had confidence in their ability to provide assessment and intervention, and that SLT for FCDs should be routine. SLTs reported using a wide variety of approaches to assessment and intervention. Barriers to effective management included a lack of resources, training, negative staff attitudes towards FND, and lack of research and evidence-based interventions. What are the practical and clinical implications of this work? This survey has found that SLTs working across the UK are providing input for patients with FCDs, but frequently reported feeling isolated and lacking clinical peer support. This shows the potential for networking groups to support SLTs to learn and share resources. There is a training need for SLTs and other healthcare professionals to tackle pervasive negative attitudes towards FND. Common themes in intervention approaches were found, but there was variability in the specific approach taken. This requires further research to guide SLTs on the best evidence-based practice.

Articulation Assessment for Tongue Cancer Patients: Using Consonant Production Performance to Capture Speech Deficits.

The purpose of this study was to thoroughly analyze postoperative consonant errors by tongue cancer (TC) patients with speech disorders and also to investigate the correlation between the pathological factors and the speech performance using our Consonant-based Articulation Assessment Battery (CAAB). The participants were 57 monolingual Mandarin TC patients (26 women, 31 men) after surgery (aged 20-80 years). All participants were literate and had normal vision and hearing, enabling them to comprehend and comply with our instructions. In order to quickly evaluate their articulation performance based on the place and manner of articulation, they were instructed to pronounce the characters in CAAB. The analysis removed speech samples impacted by speakers' dialects, while recording and documenting all other responses. The study uncovered a significant correlation between pathological factors (e.g., size of tongue resection, specific resection site, and tumor size) and the accuracy of consonant articulation. Furthermore, tongue damage predominantly impacts the place of articulation (63.85%) than the manner of articulation (20.78%). The damage in the anterior part of the tongue has the most prominent influence on consonant production. CAAB can fast capture the idiosyncratic characteristics of speech production by TC patients, and the articulation deficits are quite different from other types of organic or nonorganic speech disorders, for example, cleft lip and cleft palate. Hence, CAAB can be designated as an assessment tool for articulation disorders caused by stomatognathic damages. Our findings also shed light on the possible oral cancer surgery plan and the postoperative speech rehabilitation training.

Whole Genome Analysis in Consanguineous Families Reveals New Loci for Speech Sound Disorder (SSD).

Speech is the most common means of communication in humans. Any defect in accurate speech production ability results in the development of speech sound disorder (SSD), a condition that can significantly impair an individual's academic performance, social interactions, and relationships with peers and adults. This study investigated the genetic basis of SSD in three Pakistani families. We performed family-based genome-wide parametric linkage analysis and homozygosity mapping in three consanguineous families with SSD from the Punjab province of Pakistan. The Test for Assessment of Articulation and Phonology in Urdu (TAAPU) was used to analyze the speech articulation data and determine the Percentage Correct Consonants (PCC) score. The PCC score defined the affected and unaffected individuals in each family. Parametric linkage analysis revealed a linkage to chromosome 5 (5q21.3-5q23.1) with a significant logarithm of the odds (LOD) score of 3.13 in a Pakistani family with specific language impairment-97 (PKSLI-97) under an autosomal recessive mode of inheritance. The other two families showed a suggestive linkage at 6p22.1, 14q12, and 16q12.1 under the recessive mode of inheritance. Interestingly, homozygosity mapping showed a loss of heterozygosity in the linkage region at 5q15-5q23.1, shared among seven affected (mostly in the younger generation) and one unaffected individual of PKSLI-97. Our analysis identified the 6p22 locus previously implicated in dyslexia, childhood apraxia of speech (CAS), and language impairment, confirming the role of KIAA0319 and DCDC2 in this locus. These findings provide statistical evidence for the genomic regions associated with articulation disorder and offer future opportunities to further the role of genes in speech production.

Speech Outcomes after Delayed Hard Palate Closure and Synchronous Secondary Alveolar Bone Grafting in Patients with Cleft Lip, Alveolus and Palate.

Background The best timing of closure of the hard palate in individuals with cleft lip, alveolus, and palate (CLAP) to reach the optimal speech outcomes and maxillary growth is still a subject of debate. This study evaluates changes in compensatory articulatory patterns and resonance in patients with unilateral and bilateral CLAP who underwent simultaneous closure of the hard palate and secondary alveolar bone grafting (ABG). Methods A retrospective study of patients with nonsyndromic unilateral and bilateral CLAP who underwent delayed hard palate closure (DHPC) simultaneously with ABG at 9 to 12 years of age from 2013 to 2018. The articulatory patterns, nasality, degree of hypernasality, facial grimacing, and speech intelligibility were assessed pre- and postoperatively. Results Forty-eight patients were included. DHPC and ABG were performed at the mean age of 10.5 years. Postoperatively hypernasal speech was still present in 54% of patients; however, the degree of hypernasality decreased in 67% ( p < 0.001). Grimacing decreased in 27% ( p = 0.015). Articulation disorders remained present in 85% ( p = 0.375). Intelligible speech (grade 1 or 2) was observed in 71 compared with 35% of patients preoperatively ( p < 0.001). Conclusion This study showed an improved resonance and intelligibility following DHPC at the mean age of 10.5 years, however compensatory articulation errors persisted. Sequential treatments such as speech therapy play a key role in improvement of speech and may reduce remaining compensatory mechanisms following DHPC.

Prognostic model of pain syndrome of temporomandibular joint dysfunction in patients with occlusion-articulation disorders

Resume. Diagnostic efficiency and treatment of TMJ dysfunction was and remains an important problem modern dentistry. The urgency of this problem is determined by the great the prevalence of this pathology, the annual increase in the number of patient appeals, variety of clinical manifestations, significant difficulties in diagnosis and treatment. The aim of the work was to predict the pain syndrome of functional disorders of the masticatory apparatus when planning orthopedic treatment. Research materials and methods. Clinical and laboratory examination and orthopedic treatment of 150 patients with various variants of occlusal disorders were carried out, in 90 of them functional disorders of the masticatory apparatus were not accompanied by pain syndrome (comparison group), in 60 patients (main group) - TMJ dysfunction with pain syndrome Research results. The statistically significant data obtained by us demonstrate that the multi-level mechanism of changes in microarchitectonics due to occlusal and articulatory disorders, the influence of gender and age, and other unmodified factor balance of the work of muscle-articular structures of the dento-maxillary system can clinically manifest as a pain syndrome, and therefore requires orthopedic treatment taking into account correction of intra-articular disorders. Conclusions. Multivariate analysis of the cumulative effect of factors on the risk of pain syndrome development of functional disorders of the masticatory apparatus in case of violation of occlusal-articulatory relations allowed to create a prognostic model (model sensitivity - 0.967%, specificity - 0.971%) with a Youden index of 1.0. This prognostic model can serve as an accurate tool for the development of TMJ dysfunction pain syndrome at the stage of orthopedic treatment planning.

Discovering the gene-brain-behavior link in autism via generative machine learning.

Autism is traditionally diagnosed behaviorally but has a strong genetic basis. A genetics-first approach could transform understanding and treatment of autism. However, isolating the gene-brain-behavior relationship from confounding sources of variability is a challenge. We demonstrate a novel technique, 3D transport-based morphometry (TBM), to extract the structural brain changes linked to genetic copy number variation (CNV) at the 16p11.2 region. We identified two distinct endophenotypes. In data from the Simons Variation in Individuals Project, detection of these endophenotypes enabled 89 to 95% test accuracy in predicting 16p11.2 CNV from brain images alone. Then, TBM enabled direct visualization of the endophenotypes driving accurate prediction, revealing dose-dependent brain changes among deletion and duplication carriers. These endophenotypes are sensitive to articulation disorders and explain a portion of the intelligence quotient variability. Genetic stratification combined with TBM could reveal new brain endophenotypes in many neurodevelopmental disorders, accelerating precision medicine, and understanding of human neurodiversity.

Articulation Disorders in 5 Year Old Children at Assisi Medan Kindergarten

Articulation Disorders in 5 Year Old Children at Assisi Medan Kindergarten

AI-based automated speech therapy tools for persons with speech sound disorder: a systematic literature review

ABSTRACT In response to the limited availability of speech therapy services, researchers are developing AI-based automated speech therapy tools for individuals with speech sound disorder (SSD). However, their effectiveness/efficacy compared to conventional speech therapy remains unclear, and no guidelines exist for designing these tools or their required automation levels compared to therapy by speech-language pathologists (SLPs). Moreover, AI applications raise concerns about job displacement, biased algorithms, and privacy issues. This systematic review aims to provide comprehensive insights into AI-based automated speech therapy, focusing on (i) types of SSD addressed; (ii) AI techniques used; (iii) autonomy levels achieved; (iv) delivery modes; and (v) effectiveness/efficacy of these tools. PRISMA guidelines were applied across five databases for studies published between January 2007 and February 2022. Twenty-four studies that met the inclusion and exclusion criteria were included. Results suggest that articulation disorders are the most frequently addressed SSD. Various AI techniques were applied, ranging from traditional automatic speech recognition (ASR) to advanced methods. Most studies proposed fully automated tools, often overlooking the role of other stakeholders. Computer-based and gamified applications were the most common intervention modes. The results suggest the potential of AI-based automated speech therapy tools for individuals with SSD; however, only a few studies have compared their effectiveness/efficacy with conventional speech therapy. Further research is needed to develop speech corpora for under-represented languages, apply a Human-Centered AI approach, conduct usability studies on intervention modes, and perform more rigorous effectiveness studies.

Interdisciplinary plastic and reconstructive surgery of head and neck squamous cell carcinomas.

Squamous cell carcinomas are the most common malignancies in the oral cavity, pharynx, and larynx. Even in the age of the most modern drug treatment methods, radical resection of these tumors is and currently remains the therapeutic gold standard. The loss of anatomical structures associated with surgery inevitably increases the functional deficits caused by the tumor itself. In this context, the extent of functional deficits is largely determined by the extent of resection. Complete organ resections, such as glossectomy, complete palate resection, laryngectomy, or transverse pharyngo-laryngectomy, lead to severe functional deficits, such as swallowing disturbances with life-threatening aspiration and articulation disorders up to the inability to speak. With the help of plastic reconstructive surgery, the lost tissue can be replaced and the specific functions of the upper aerodigestive tract can be preserved or restored.In recent decades, reconstructive surgical procedures have developed enormously in the treatment of malignant tumors of the head and neck. In order to make optimal use of them, a comprehensive, interdisciplinary therapy concept is a prerequisite for positive oncological and functional outcome. In addition to general medical and social parameters, surgical parameters play a crucial role in the choice of the reconstruction method. The extent to which the surgical measures must be interdisciplinary depends on the localization of the defects in the head and neck region and on the type of replacement tissue required. Here, the expertise of plastic surgery, oral and maxillofacial surgery, and abdominal surgery comes into play in particular. The use of different tissues, the combination of different grafts and flaps, or the preforming of donor regions allow reconstructions far beyond the level of simply restoring surface integrity. The functional results and thus the quality of life of patients after surgical therapy of extensive tumors of the mentioned localizations depend decisively on the type of reconstruction. Therefore, in the following review, special emphasis 1 be placed on the choice of reconstruction method and reconstruction technique for tissue loss after resections of HNSCC.

Prevention of Articulation Disorders in Preschool-Age Children

Articulation disorders have been a most common disorder in recent years. They are the reason for the delayed mental, communicative, and emotional-behavioural development of preschool-age children. Of particular importance for the personal development of children are early diagnosis and treatment of articulation disorders. The purpose of this article is to present and analyse practices for the prevention, diagnosis, and elimination of speech disorders from an early age.

The relationship of anterior malocclusion with phoneme articulation in children aged 6-12 years in Makassar, Indonesia

Objective: This study aims to establish the correlation between anterior malocclusion and phoneme articulation among children between 6 and 12 years old in Makassar, Indonesia. Material and methods: A cross-sectional study was conducted on 157 elementary school students aged 6-12 in Makassar City, Indonesia. The sampling method used was purposive to identify students who met specific inclusion and exclusion criteria. Each student underwent an examination to determine the presence of anterior dental malocclusion and articulation check using a multi-word format consisting of phonemes. The data was analyzed using SPSS version 27. Result: The statistical tests conducted using the Chi-Square method shows a significant correlation between protrusion, diastema, deep bite, and crossbite with phoneme articulation errors, with a p-value of less than 0.05. Crowding is the most prevalent among all types of anterior malocclusion, while omissions are the most common type of phoneme articulation disorder. Conclusion: Our findings indicate that children between ages 6 and 12 in Makassar, presenting anterior malocclusion, could potentially demonstrate phoneme articulation irregularities. These may be associated with such conditions as protrusion, diastema, deep bite and crossbite.

Treatment Approaches to Speech Sound Disorders: A Scoping Review

Objective: The objective was to highlight and review different therapeutic approaches to cater to speech sound disorders in Pakistan. Methodology: To find the different therapeutic approaches, a literature search for related articles/ publications was conducted using the Keywords “speech sound disorders, phonological disorders, articulation disorder and a combination of words using search engines like Google &amp; and databases like PubMed and other websites. Around 130 publications, reports, and articles were downloaded, of which 25 were used for literature review. Results: There are many treatments used to cater for speech sound disorders including contextual utilisation, phonological contrast, complexity, core vocabulary, cycles phonological pattern, distinctive feature therapy, metaphor therapy, naturalist speech intelligibility, non-speech oral-motor therapy, speech sound perception training and bilingual or cross-lingual approach. However, novel trends like the use of hybrid treatment, speech motor learning- phonetic placement approach, blocked practice versus serial practice schedule &amp; interventions using biofeedback need to be utilized. Conclusion: Treatment approaches in use include contextual utilisation, phonological contrast, complexity, core vocabulary, cycles phonological pattern, distinctive feature therapy, metaphor therapy, naturalist speech intelligibility, non-speech oral-motor therapy, speech sound perception training and bilingual or cross-lingual approach, however, novel treatments need to be utilised. Keywords: Articulation disorders, Phonological disorders, Phonological Representations

Children mandibular fractures: Epidemiological and anatomo-clinical aspects

IntroductionMaxillofacial trauma in children is uncommon, accounting for between 1 % and 14 % of all facial trauma in the general population. ObjectiveTo describe the epidemiological and anatomical-clinical aspects of mandibular fractures in children. Material and methodThis was a retrospective descriptive cross-sectional study with non-probabilistic accidental sampling. It took place in the maxillofacial surgery and stomatology department of Cocody University Hospital in the Republic of Côte d'Ivoire, over a 20-year period (2000–2019). The study population consisted of patients aged 0–16 years admitted to our department for a mandibular fracture. At the end of this study, we identified 58 patients. Data was entered using Excel 2016. Tables and graphs were processed using Excel version 2016. Resultswe have identified 58 patients. The mean age of patients was 9.35 ± 2.1 years, with extremes of 1 and 16 years, and a sex ratio of 2,22 in favouring men. The 6–12 age group was the most affected (n: 34 cases or 60.35 %). Soft tissue wounds were present in all our patients, followed by peri-mandibular swelling (n: 37 cases or 63.79 %) and disorders of the dental articulation (n: 28 cases or 48.2 %). Condylar fractures were the most frequent (46.87 %).Mandibular fracture lines were uni-focal in 75 % of cases. These fractures were associated with other facial lesions in 48.28 % of cases and with extra-facial lesions in 34.48 % of cases. ConclusionMandibular fractures are common in maxillofacial trauma in children. Condylar fractures are the most common, almost always associated with chin injuries. Hence the importance of a systematic examination of the mandibular condyles.

Complaints, Diagnosis, Follow-up and Treatment of Patients Applying to 0-6 Years Old Child Psychiatry and Developmental Pediatrics Outpatient Clinic

Aim: By studying children aged 0-6 with outpatient and health board admissions, we aimed to contribute valuable insights to the literature on early childhood support, focusing on admission complaints, diagnosis distribution, treatments, and patient follow-ups. Materials and Methods: Between 01.08.2022 and 01.02.2022, patients aged 0-6 from Diyarbakir Gazi Yaşargil Hospital's Pediatric and Adolescent Mental Health and Developmental Pediatrics clinic, including those seeking health board evaluations, were studied. This prospective analysis examined patient demographics, complaints, diagnoses, health board interactions, treatments, and additional medical conditions. Patient follow-up data were scanned from the system for analysis before concluding the retrospective study. Results: Of the 600 patients included in the study, 337 patients came to the health board outpatient clinic, 160 to the child psychiatry outpatient clinic and 103 to the developmental pediatrics outpatient clinic. 220 (36.7%) were female and 380 (63.3%) were male. The most common presenting complaints of the patients were speech delay, mobility, report renewal and irritability. In our study, the presenting diagnoses were global developmental delay, isolated speech delay, ASD, ADHD, articulation disorder, behavioral problems, stuttering and specific learning disorder (SLD) with decreasing frequency. It was observed that 77.5% of the patients had no follow-up and the highest rates of follow-up were ADHD (67.4%) and ASD (56.9%). It was observed that 87.5% of the patients with a health board application had no follow-up. Conclusion: Determining the diagnosis, follow-up and treatments of the patients may guide the areas in which child psychiatrists and developmental pediatricians should work more intensively in the future. Early diagnosis, screening initiatives, awareness campaigns, and training for parents, teachers, and health professionals, along with telehealth, multidisciplinary strategies, and school collaborations, enhance health board applications and patient follow-up.

The relationship of developmental disorder of articulation and oral praxis

The relationship of developmental disorder of articulation and oral praxis