What is the cause of anomalous (abnormal) articulation?

From the Guidelines

Anomalous articulation should be treated with a multidisciplinary approach, incorporating education, symptomatic, psychological, and medical interventions, as outlined in the consensus recommendations for speech and language therapy 1.

Treatment Overview

The treatment of anomalous articulation involves several domains of intervention, including:

• Education and explanatory approaches, such as reassurance and education about the nature of symptoms and good prognosis for resolution 1
• Symptomatic strategies, including reduction of excessive musculoskeletal tension, elimination of secondary or accessory movements, and focusing on normal movements and sounds 1
• Psychological interventions, such as attention to psychosocial issues, addressing cognitive features related to locus of control and executive function, and helping the person gain insight into positive changes in articulation 1
• Medical management, including provision of information and advice to reduce acid reflux and signposting for appropriate medical management of acid reflux and/or post nasal drip if present 1

Specific Interventions

Some specific interventions that may be effective in treating anomalous articulation include:

• Articulation drills and phonological awareness activities
• Motor practice exercises performed 2-3 times weekly for several months, with daily home practice of 10-15 minutes
• Play-based activities for children to maintain engagement
• Counselling by the speech and language professional in relation to psychological and life stresses contributing to symptoms
• Cognitive Behavioural Therapy strategies to identify and challenge maladaptive beliefs, cognitions, and behaviours

Importance of Early Intervention

Early intervention is crucial for better outcomes, as neuroplasticity allows for more effective speech pattern corrections in younger individuals 1. Consistency of practice, severity of the disorder, underlying causes, and the individual's motivation and support system all play a role in determining treatment success.

Key Considerations

It is essential to address any comorbid or secondary psychiatric disorders, such as anxiety or depression, and to provide education about the physiology of anxiety and the importance of avoiding avoidance 1. Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants or low-dose amitriptyline may be helpful for globus, and traditional treatment approaches used for developmental and neurological articulatory disorders may also be effective 1.

From the Research

Anomalous Articulation

• Anomalous articulation refers to abnormal joint formations or movements that can cause various symptoms, including pain and discomfort.
• In the context of lumbosacral articulations, anomalous unilateral formations can lead to low-back pain, as seen in a study published in Spine 2.
• This study found that resection of the transverse process may be a worthwhile procedure for patients with anomalous unilateral lumbosacral articulations and low-back pain, especially if local anesthesia into the joint provides pain alleviation.

Articulation Disorders

• Articulation disorders can also refer to speech disorders, where individuals have difficulty pronouncing certain sounds or words.
• A review of treatment research related to articulation and phonological disorders found significant differences in research designs and variables under investigation between the 1970s and 1980s 3.
• The study highlights the importance of critical analysis and suggestions for changes in research designs to improve treatment outcomes for individuals with articulation disorders.

Radiological Assessment

• Radiological assessment plays a crucial role in evaluating lower limb alignment and detecting anomalous articulations.
• A study published in EFORT open reviews emphasizes the importance of full-length standing radiographs in defining and measuring limb alignment 4.
• Another study published in Foot and ankle surgery found that routine computed tomography (CT) scans can help improve the accuracy of diagnosis and reduce the risk of ankle osteoarthrosis by detecting overlooked pathologies, such as Tillaux fracture and syndesmosis injury 5.

Acoustic Characteristics

• Anomalous articulation can also affect the acoustic characteristics of speech sounds, such as nasalized vowels.
• A study published in The Journal of the Acoustical Society of America found that oral articulation can compensate for velopharyngeal dysfunction, which can involve anomalous velopharyngeal closure and hypernasality 6.
• The study highlights the importance of understanding the effects of oral articulation on the acoustics of nasalized vowels to develop compensatory articulation strategies.