Intro to Speech Language Pathology

Structures of the Respiratory System

(1) the pulmonary apparatus, which is further subdivided into the lungs, the trachea (windpipe), and the pulmonary airways (2) The chest wall (thorax), comprising the rib cage wall, the abdominal wall, the abdominal content, and the diaphragm. oThe structures of the chest wall surround and encase the pulmonary apparatus, and together they form a single functional unit o The lungs are a pair of air filled elastic sacs that change in size and shape and allow us to breathe. o The left lung is smaller than the right to allow room for the heart. o Air moves to and from the lungs via the trachea and the intricate network of branching tubes called bronchi

Three Physiological subsystems are involved in speech production

(1) the respiratory system provides the driving force for speech by generating positive air pressure values beneath the vocal folds. (2) The vocal folds, anatomical structures in the laryngeal system or larynx, vibrate at high rates of speed, setting air molecules in the vocal tract into multiple frequencies of vibration (3) The articulatory/ resonating system acts as an acoustic filter, allowing certain frequencies to pass into the atmosphere while simultaneously blocking other frequencies.

the primary interrelated components of human languages

Form, Content, and Use

Language is generative

Language is generative; this means that you can create new utterances. As a speaker, you don't just quote or repeat what you heard before. Instead, you present your own ideas in an individual way. Imagine trying to have a conversation if all you could do was imitate your conversation partner

Adduction

Vocal fold adduction (moving together) is accomplished by contraction of the lateral cricoarytenoid and arytenoid (transverse and oblique) muscles. The lateral cricoarytenoid brings the front portion of the vocal folds together , while the arytenoids bring the back portion of the vocal folds together.

Communication Disorder

o A communication disorder impairs the ability to both receive and send, and also process and comprehend concepts or verbal, nonverbal, and graphic information. o A communication disorder may affect hearing, languages and/or speech processes; may range from mild to profound severity; and may be developmental or acquired. o One or a combination of communication disorders may be presented by an individual, and may result in a primary disability or may be secondary to other disabilities. o In short, a communication disorder may affect any and all aspects of communication, even gesturing. A communication disorder may affect hearing, language (the code we use to communicate), and/ or speech (our primary mode or hammer of communication). o Communication disorders do not include communication differences, such as dialectal differences or speaking another language. While these differences can lead to communication difficulties, they are differences, not disorders, and cannot be treated by SLPs as if they are. o We can further define communication disorders as consisting of disorders of speech (articulation, voice, resonance, fluency), oral neuromotor patterns of control and movement, feeding and swallowing disorders, language and/or literacy impairment, cognitive and social communication deficits, and hearing and processing difficulties.

Hearing disorder

o A hearing disorder is a result of impaired sensitivity of the auditory or hearing system.

Langauge Disorder

o A language disorder, is an impairment in comprehension and/ or use of spoken, written, and/ or other symbol systems, such as English.

Auditory Processing Disorders

o A person with an auditory processing disorder (APD) may have normal hearing but still have difficulty understanding speech. o They struggle to keep up with conversation, to understand speech in less than optimal listening conditions, to discriminate and identify speech sounds, and integrate what they hear with nonverbal aspects of communication. o These difficulties are sometimes traced to tumors, disease, or brain injury, but often the cause is unknown.

Speech Disorder

o A speech disorder may be evident in the atypical production of speech sounds, interruption in the flow of speaking, or abnormal production and/ or absence of voice quality, including pitch, loudness, resonance, and/ or duration. o For example, when you had laryngitis your voice was temporarily affected.

Teeth

o Adults have 32 teeth that are held within the alveolar processes (thick spongy projections) of the mandible and maxilla (upper jaw) inside the oral cavity. o Horizontal bones of the maxilla form the bony hard palate, which comprises the front two thirds of the roof of the mouth

Follow up and Maintenance

o After a client has been dismissed from therapy, an SLP must take steps to ensure that the progress that was achieved is not lost. This is done in two ways: Upon dismissal, the client or family should be encouraged to return when anyone feels a need. o more reliable is the establishment of a regular follow up schedule o If warranted, retesting may be suggested, and booster treatment may be provided if needed.

Langauge Disorders

o Although we focus on form, content, and use, language impairments tend to cross these boundaries. A deficit in one area tends to affect the others there are o Disorders of form o Disorders of Content o Disorders of Use

Measuring Effectiveness

o An SLP determines readiness for dismissal from therapy by assessing its effectiveness. Did the client meet the long term goals and short term objectives? o SLP designed post therapy tests similar to those used to determine baselines are normally used tho answer this question. o Client should be able to self monitor and self correct when needed. o If therapy has been effective, the client has been successful in generalizing learned skills to the out-of-clinic world.

Anatomy and Physiology

o Anatomy is the study of the structures of the body and the relationship of these structures to one another. o Physiology is a branch of biology that is concerned with the functions of organisms and bodily structures.

Articulation: Prosody --> Suprasegmentals

o Articulation refers to the way in which speech sounds are formed. o How do we move our tongue, teeth, and lips to produce the specific phonemes of a language? How do we combine these individual sounds to form words? o The component of speech that includes rate and rhythm is referred to as prosody. o Prosodic features are known as suprasegmentals o Supra - means "above" or "beyond", so suprasegmental features go beyond individual speech sounds (or segmental units) and are applied to words, phrases, or sentences. o Stress and intonation are also suprasegmental features of speech production.

Nonverbal communication

o Artifacts o kinesics o Space and time o Although most humans rely heavily on spoken communication, some researchers report that about two thirds of human exchanges of meaning take place nonverbally. o The term nonverbal encompasses both the suprasegmental aspects of speech and the nonvocal (without voice) and nonlinguistic (non language) aspects of communication.

Phonology

o Aspect of form o The sound system of English, consists of about 43 phonemes, or unique speech sounds. o Although different languages use many of the same phonemes, variations exist. Spanish and German, to name only two, do not use the English "th". o Speech sounds are not combined arbitrarily. Phonotactic rules specify how sounds may be arranged in words. Like rules of grammar, phonotactic rules are not universal. For example, "k" and "n" cannot be blended in spoken English. For this reason, the "k" in "knife" and "Knoxville" is silent for native English speakers

Defining the problem

o Assessment of communication disorders is the systematic process of obtaining information from many sources, through various means, and in different settings to verify and specify communication and swallowing strengths and weaknesses, identify possible causes of problems, and make plans to address them. o If a problem is identified, an SLP may make a diagnosis, which distinguishes an individual's difficulties from the broad range of possible problems. o Although a diagnostic report might include a label such as dysphonia, it more importantly contains a complete description of this disorder and reflects the person's ability to communicate, variability of symptoms, severity, and possible causes. o A person who has been identified during screening may have a communication disorder. A screening is not a diagnostic evaluation. Screening simply suggest which individuals should receive further evaluation.

Audiologists

o Audiologists are specialists who measure hearing ability and identify, assess, manage, and prevent disorders of hearing and balance o Audiologists evaluate and assist individuals with auditory processing disorders (APD), sometimes called central auditory processing disorders. o They prevention o Work to improve communication o Hearing aid work o Advocate for the individual and more Credentials: o 3 to 5 years of professional education beyond the bachelor's degree o they need a doctoral degree that may be an audiology doctorate (AuD) or a doctor of philosophy degree (PhD) or a doctor of education degree (EdD) in audiology. o after a person has earned a doctorate, obtained the required preprofessional as well as paid clinical experience, and passed a national examination, she or he is eligible for the Certificate of Clinical Competence in Audiology (CCC - A). In addition, states require audiologists to obtain a state license.

Central Auditory Processing Disorders

o Auditory impairment may include central auditory processing disorders, or deficits in the processing of information from audible signals.

Baseline Data

o Before beginning a program of intervention, an SLP obtains baseline data; that is, the SLP tries to elicit target behavior(s) multiple times and under multiple conditions, and records the accuracy of the client's responses. o This gives the SLP information about the client's starting point. Baselines are essential in determining a client's progress and the success of a treatment program.

Breathing for the purposes of Speech

o Breathing for the purposes of speech production are different from resting tidal breathing in a number of ways. o First, contraction of the diaphragm produces rapid, forceful inspirations o Furthermore, the time spent inhaling is short relative to the time spent exhaling, which is much longer. o Unlike expiration during quiet breathing, active muscle contraction of both inspiratory and expiratory muscles is needed during speech to prevent all the air from rushing out of the lungs too quickly.

Disorders of Content

o Children and adults with limited vocabularies, those who misuse words, and those with word finding difficulties may have disorders of content or semantics. o Similarly, limited ability to understand and use abstract language, as in metaphors, proverbs, sarcasm, and some humor, suggests semantic difficulties. o A persistent pattern of avoiding naming objects and referring instead to "the thing" is another indication of a disorder of content. o Although limited experience or a concrete learning style may contribute to this problem in youngsters, among older people cerebrovascular accidents (strokes), head trauma due to accidents, and certain illnesses, such as cognitive impairment (previously called dementia), may result in god retrieval problems and other content related difficulties.

Aspects of Communication

o Communication can take many forms and can involve one or a combination of our senses, including sight, hearing, smell, and touch. It can include verbal, such as the spoken or written word, and nonverbal means, such as naturalistic gestures, facial expressions, or signs. o The primary vehicle of human communication is language, and speech is the primary means of language expression for most individuals.

Communication

o Communication is an exchange of ideas between sender(s) and receiver(s). It involves message transmission and response or feedback

The Environment (as part of sociolinguistics )

o Communication reflects the cultures of the speakers but it also occurs within an environment or context o In fact, the act of communication often only makes sense within a context. o The communication environment includes not only the location in which communication occurs, but also the people involved and the event in which they are involved o Even when we write, we must consider the reader and must build the context on paper from the language available to us.

Congenital v Acquired

o Congenital disorders are present at brith o Acquired disorders result from illness, accident, or environmental circumstances anytime in later life. o An individual may have a disorder that is either congenital or acquired, or both. o And an individual's disorder may range from borderline or mild to profoundly severe.

Hearing Disorders

o Deafness o Hard of Hearing o Auditory processing disorders o A hearing disorder results from impaired sensitivity in the auditory or hearing system. o It may affect the ability to detect sound, to recognize voices or other auditory stimuli, to discriminate between different sounds, such as mistaking the phoneme /s/ for /f/, and to understand speech.

Evidence Based Practice

o Deciding on the most efficacious intervention is a portion of something called evidence based practice (EBP). o EBP is an essential part of effective and ethical intervention. o The primary benefit is the delivery of optimally effective care to each client. o Using EBP, clinical decision making becomes a combination of scientific evidence, clinical experience, and client needs. o In other words, research, specifically the small portion of research directly relevant to decisions about practice, is combined with reason when making decisions about treatment approaches o Although EBP can improve and validate clinical services, we must acknowledge that it can be difficult to incorporate into everyday clinical settings because of the time required for SLPs to comb through relevant research. In addition, evidence may be limited, contradictory, or non existent. o In the last analysis, however, the necessity of providing the best intervention services possible must be the foremost professional concern.

Swallowing disorders - dysphagia

o Difficulty swallowing is called dysphagia, and stated simply it mens difficulty moving food or liquid from your mouth to your stomach. o In some cases it may be associated with pain, or swallowing may be impossible. o Persistent dysphagia may indicate a serious medical condition. o Although swallowing difficulties may occur at any age, dysphagia is more common in older adults. o Causes vary and treatment depends on the cause o These causes are usually associated with other neuromuscular disorders

Speech Disorders

o Disorders of speech may involve - Articulation (the production of speech sounds) - Fluency (rhythm and rate) - Voice (pitch, loudness, and quality) o They may affect people of all ages and can be congenital or acquired and can have different severities.

Cultural identity (as part of sociolinguistics)

o Each of us is a member of a language community. The more you understand about your own culture and that of the people with whom you communicate, the more effective your interaction will be. o Speakers and listeners must share competence in a common language if they are to communicate fully. o Even when two people come from the same langue background, "perfect" communication is rare. This is because successful communication depends not just on language and speech but on related factors, such as age, socioeconomic status, geographical background, ethnicity, gender, and ability. o Where you interact also influences what you will say

Etiology

o Etiology, the cause or origin of a problem, may be used to classify a communication problem. o Disorders may be due to faulty learning, neurological impairments, anatomical or physiological abnormalities, cognitive deficits, hearing impairment, damage to any part of the speech system, or a combination

Muscles of Expiration

o Expiration allows CO2 to be expelled from the body via the lungs and for speech to be produced. o The most important muscles of expiration are located in the front and on the sides fo the abdomen. During expiration, these muscles (Abdominal aponeurosis, External oblique muscle, Internal oblique muscle, Transversus abdomens muscle, and Rectus abdomens muscle), assists the diaphragm's movement back to its relaxed dome shaped configuration. o Numerous other muscles located on the front and back of the thorax may also contribute to respiration. The use of other muscles during inspiration and expiration may be related to body position, certain pathological states, and environmental conditions.

Fluency: rate

o Fluency is the smooth, forward flow of communication. It is influenced by the rhythm and rate of speech. (I THOUGHT THIS WOULD BE PROSODY????) O Every language has its own rhythmic pattern, or timing. o Pauses? Phrasing? o Timing is not an isolated feature of speech. A word or syllable that is held tends to be emphasized and said more loudly. o The speed at which we talk is our rate. It may provide clues about where we come from. Or if we are in a hurry or impatient. Or slow speech may connote a relaxed or casual demeanor

Disorders of Fluency

o Fluency is the smooth, uninterrupted flow of communication. o Certain types of fluency disruptions are fairly common at different ages. o Because these kinds of speech patterns are so common, it is sometimes referred to as developmental disfluency. o Even typically fluent adults use fillers ("um" "ya know"), hesitations (unexpected pauses), repetitions ("g-go-go"), and prolongations ("wwwwell"). o When these speech behaviors exceed or are qualitatively different from the norm or are accompanied by excessive tension, struggle, and fear, they may be identified as stuttering. o Fluency disorders are generally first noticed before 6 years of age. o If remediation efforts are not made or are unsuccessful, this condition might continue and even worsen by adulthood. o Adult onset of disfluency also occurs o Advancing age, accident, and disease can all disrupt the normal ease, speed, and rhythm of speech.

Form

o Form consists of phonology, morphology, and syntax

Hearing Scientists

o Hearing scientists investigate the nature of sound, noise, and hearing. They may work with other scientists in the development of equipment to be used in the assessment of hearing. o They are also involved in the development of techniques for testing the hard to test. o Hearing scientists develop and improve assistive listening devices such as hearing saids and telephone amplifiers to help people who have limited hearing. o In addition, hearing scientists are concerned with conservation of hearing and are engaged in research to measure and limit the impact of environmental noise.

Assessment Procedures - dynamic assessment - Speech and/ or language sampling

o Ideally a clinician should sample a broad variety of communication skills through multiple procedures in several settings. o The focus should be on the collection of authentic data- that is, actual real life information - in sufficient quantity to be able to make meaningful and accurate decisions. o Each client has individual needs. An SLP must attempt to determine which needs are paramount at a particular time and then develop a plan to meet these needs. o By using multiple measures and reports, an SLP or audiologist tries to obtain the most accurate description of a child's communication possible. o These methods may include: - A case history filled put by a parent, family member, professional, or the client - A questionnaire completed by a parent, family member, professional, or the client - An interview with a parent, family member, and/or the client - A systematic observation of the client's communication and/or swallowing skills - Testing with more than one assessment tool and including a hearing screening and an examination of the peripheral speech mechanism - dynamic assessment - communication sampling and analysis o Most tests are norm referenced, meaning they yield scores that are used to compare a client with a sample of simpler individuals. o In contrast, a criterion referenced test evaluates a client's strengths and weaknesses with regard to particular skills and does not make comparisons to other children. This more descriptive method is usually reserved for dynamic assessment and sampling. o Dynamic assessment includes probing to explore a client's ability to modify behavior by producing previously misarticulated sounds, learning a language rule, reducing disfluencies, and the like. The goal is to mesh more flexible non standardized approaches with more formal, structured methods found in most tests. Dynamic assessment often takes the form of a test- teach - test paradigm to examine the "teachability" of a communication feature. The child's potential for learning is assessed by giving small amounts of assistance and determining the difficulty for the child of performing the newly learned behavior. o Most clinicians also use a speech and/or language sampling technique when assessing the communication of both children and adults. o With adult clients, sampling can be accomplished while reviewing the case history with clients or asking them to explain how they spend their day or to tell about their last vacation. o A case history can be extremely important in identifying the cause(s). General health information is important too. A case history can help identify the location of the difficulty. o Other evaluations may include a neurological assessment of neuromuscular control, motor and sensory assessment, a guided eating assessment including a variety of liquids and solids, an oral examination, and laboratory tests as needed to screen for infections and inflammatory conditions.

Efficacy and Effectiveness

o In the discussion of EBP we used these two terms, and it is important to know the difference. o Technically, efficacy as it relates to clinical outcomes is the probability of benefit from an intervention method under ideal conditions. There are three key elements to this definition: - It refers to an identified population, such as adults with global aphasia, not to individuals - The treatment protocol should be focused, and the population should be clearly identified. - The research should be conducted under optimal intervention conditions. Of course, results in real life clinical situations may differ somewhat. - o It is also important for SLPs to recognize that efficacy is never an all or nothing proposition o Effectiveness is the probability of benefit from an intervention method under average conditions o The effectiveness of treatment is the outcome of real world application of the treatment for individual clients or subgroups. In short, effectiveness is a measure of what works. Valid clinical studies must be realistically evaluated for the feasibility of applying them to intervention with specific populations and individuals. o One way of determining potential effectiveness, but not the only one, may be a clinical approach's reported efficiency. Efficiency results from application of the quickest method involving the least effort and the greatest positive benefit, including unintended effects.

Intervention with communication and swallowing disorders

o Intervention for individuals with communication and swallowing disorders is influenced by the nature and severity of the disorder, the age and status of the client, and environmental considerations, as well as personal and cultural characteristics of both client and clinician. Despite this, some general principles and procedures can be identified. o Providing culturally responsive intervention is extremely important for children from culturally and linguistically diverse (CLD) backgrounds. o Intervention can take a variety of forms based on they type of disorder, the aspects of communication affected, the age of the client, and the severity of the disorder, to name just a few of the variables.

Laryngeal system with age

o It begins higher up and moves down as you age. It reaches its final position between 10 and 20 years of age. o The laryngeal cartilage increases in size and be cause less pliable o Hyoid bone ossifies (turns to bone) by 2 years of age o Vocal folds grow. The increase In length of the vocal folds is equal in boys and girls until puberty. o THE SEX DIFFERENCE IN ADULT VOCAL FOLD LENGTH ACCOUNTS FOR THE FACT THAT MEN NORMALLY HAVE LOWER PITCHED VOICES THAN WOMEN. o Vocal folds become stiffer and less flexible with age.

Kinesics

o Kinesics refers to the way we move our bodies, called body language. This includes overall body movement and position as well as gestures and facial expression. o Signing may be a primary means of communication for someone who has deafness.

Language Scientists

o Language Scientists may investigate the ways in which children learn their native tongue. o They may study the differences and similarities of different languages. o Some language scientists explore the variations of modern day English (dialects) and how the language is changing. o Others are concerned with language disabilities and study the nature of language disorders in children and adults.

Language

o Language is a socially shared code that is used to represent concepts. This code uses arbitrary symbols that are combined in rule-governed ways o Taken together, the characteristics of language are that it is: - A socially shared tool - A rule governed system - An arbitrary code - A generative process - A dynamic scheme o Language is a social tool for relating to others and for accomplishing a variety of objectives \ o Others must share the language code if communication is to occur o Each language consists of rules that dictate how these words are arranged in sentences.

Language is dynamic

o Languages are also dynamic; they change over time o American English adds five or six new words each day, many from other languages. o Pronunciation, grammar, and ways of communicating also change.

Communication and swallowing disorders can be secondary to other disabilities

o Most communication disorders are secondary to other disabilities o For example, people with cerebral palsy typically have motor deficits beyond speech and swallowing. o Children with learning disabilities are especially likely to have language difficulties, but may also have articulation, voice, fluency, and/or hearing deficits.

Assessment of Communication ad swallowing disorders

o Not everyone is assessed for communication disorders. Formal assessment occurs only after someone recognizes the possibility of a problem. Selection for assessment may come from referral by another professional or concerned adult, such as a pediatrician or parent, or from screening. o The purpose of screening is to determine whether a problem exists. o Every state in the US requires that hearing screening tests be given to infants at their birthing facility or as soon after birth as possible. These are what you do to assess and help o Defining the problem o Assessment goals o Assessment procedures o Evidence based practice

Behavioral Objectives

o Once a clinician has obtained base line data, he or she develops short term objectives. o A behavioral objective is a statement that specifies the target behavior in an observable and measurable way. To do this requires that the clinician identify what the client is expected to do, under what conditions, and with what degree of success. The letters ABCD might help you to remember the format for writing behavioral objectives: A. Actor. Who is expected to do the behavior? B. Behavior. What is the observable and measurable behavior? C. Condition. What is the context or condition of the behavior? D. Degree. What is the targeted degree of success?

Use

o PRAGMATICS o Use, or pragmatics, is the driving force behind all aspects of language. We speak for a reason. It is the purpose of our utterance that primarily determines its form and content. o Who and where you are, whom you are with, and the time of day also influence what you say. o Pragmatic rules vary with culture o For example, in the US business meetings tend to be very task oriented. Very little time is spent on social exchanges; the work to be done has center stage. In Saudi Arabia, however, when two people meet for the first time for business purposes, they might spend the entire session talking about family and friends and not get to the meat of the business until the second meeting.

Pitch and intonation

o Pitch is a listener's perception of how high or low a sound is; it can be physically measured as frequency or cycles per second, called hertz. o Habitual pitch is the basic tone that an individual uses most of the time. Our habitual pitch tells something about who we are (gender maybe). o Pitch movement within an utterance is called intonation.

Disorders of use

o Pragmatic language problems may be related to limited or unacceptable conversational, social, and narrative skills; deficits in spoken vocabulary; and/ or immature or disordered morphology, phonology, and syntax. o Examples of impaired pragmatic language skills might include difficulty staying on topic, providing inappropriate or incongruent responses to questions, and constantly interrupting the conversational partner.

prevalence v incidence

o Prevalence refers to the number or percentage of people within a specified population who have a particular disorder or condition at a give point in time o Incidence refers to the number of new cases of a disease of disorder in a particular time period. o Prevalence is the number of new and old cases in a particular time period o Current estimates suggest that about 17% of the total US population have some communicative disorder. o About 11% have a hearing loss o Approx 6% have a speech, voice, or language disorder. o Estimated that between 3% and 10% of Americans have voice disorders. o Language disorders occur in 8% to 12% of the preschool population, but it decreases through the school years. o It is estimated that 6 to 10 million Americans (about 3% of the population) have dysphagia. o and more statistics in the book

Disorders of Articulation - dysarthria

o Production of speech requires perception and conceptualization of the speech sounds as well as motor movements to form the sounds in isolation and connected speech o You must have both a mental/ auditory image of the sound you are going to say and the neuromuscular skills to produce the sound o The cognitive and theoretical concepts of the nature, production, and rules for producing and combining speech sounds in language is known as phonology, which we know from the previous section is an aspect of language. The actual production of these sounds is called articulation. o It is not always easy to determine whether an individuals speech sound error indicate an impairment of phonology or articulation. To sort this our, SLPs identify the phonemes that are incorrectly produced and look for error patterns that may point to phonological difficulties. o An SLP is interested in a client's ability to move the structures needed in speech, such as the jaw, lips, and tongue. o The CAUSES of articulation disorders include neuromotor problems such as cerebral palsy, physical anomalies such as cleft palate, and faulty learning. o When paralysis, weakness, or poor coordination of the muscles for speech result in poor speech articulation, the disorder is called dysarthria. o In contrast, apraxia of speech, although also poor articulation due to neuromotor difficulties, appears to be due to programming the speech mechanism, not muscle strength.

Resting Tidal Breathing

o Quiet breathing, or resting tidal breathing, is breathing to sustain life. o The rate and depth of breaths taken during tidal breathing are determined by your body's oxygen needs and the amount of CO2 in the blood. o It involves the contraction of the diaphragm, moving it downward and slightly forward, which in turn expands the rib cage wall and moves the abdominal wall outward. Expansion of the rib cage wall also causes expansion of the lungs. This results in an increase in lung volume and a decrease in alveolar pressure (i.e. pressure within the lungs) below that of atmospheric pressure. Air then rushes into the lungs o When the resting tidal inspiration cycle ends, expiration (or exhalation) begins. o Expiration results from the decrease in the size of the rib cage wall, and thus compression of the lungs, which in turn increases the pressure within the lungs. Air then rushes out of the lungs until equilibrium with atmospheric pressure is reached. o Expiration during quiet breathing is a relatively passive event, achieved by gravity and the natural tendency of the pulmonary chest wall unit to return to its relaxed state. o However, in the upright body position, the abdominal wall muscles remain active throughout the resting tidal breathing cycle. o During resting tidal breathing, the duration of inspiration and expiration are relatively equal. o Breathing for the purposes of speech production are different from resting tidal breathing in a number of ways.

Objectives of intervention

o Regardless of the specific nature of a problem, intervention in SLP has as its overriding goal the improvement of the clients communication and swallowing skills: 1. The client should show improvement not just in a clinical setting; progress should generalize to his or her real world environments, such as home; school, and work 2. The client should not have to think about what has been learned; in large part, it should be automatic 3. The client must be able to self monitor. Although modifications should be automatic, they will still require monitoring. The client should be able to listen to and observe himself or herself, and make corrections as needed without the therapist's being present. 4. The client should make optimum progress in the minimum amount of time 5. Intervention should be sensitive to the personal and cultural characteristics of the client.

Content

o SEMANTICS o Because language is used to communicate, it must be about something, and this is its content, meaning, or semantics. o Semantic features are the pieces of meaning that come together to define a particular word. For example, girl and woman share the semantic features of feminine or human, but child is generally considered a feature in girl and not in woman. o Each word has multiple meanings, as you can quickly verify by looking in the dictionary.. o It is the other aspects of language, such as use and form, that determine which of these definitions is appropriate in context.

Lifetime services

o SLPs can work with people of any age

Sociolinguistics

o Several variables affect communication and its success or failure. These include cultural identity, setting, and participants, to name a few. The study of these influences on communication is called sociolinguistics.

A team approach

o Specialists in communication disorders do not operate in a vacuum. They work closely with family members, regular and special educators, psychologists, social workers. doctors and other medical personnel, and occupational, physical, and music therapists. They may collaborate with physicists and engineers.

Speech Language Pathologists

o Speech Language Pathologists (SLPs) are professionals who provide an assortment of services related to communicative disorders. o An SLP is supposed to identify, assess, treat, and prevent communication disorders in all modalities (including spoken, written, pictorial, and manual), both receptively and expressively. This includes attention to physiological, cognitive, and social aspects of communication. o SLPs also provide services for disorders of swallowing and may work with individuals who choose to modify a regional or foreign dialect. Credentials o SLPs have a master's or doctoral degree and have studied typical communication and swallowing development; anatomy and physiology of the speech, swallowing, and hearing mechanisms; phonetics; speech and hearing science; and disorders of speech, language, and swallowing. o Public school certification normally stipulates basic and advanced coursework, clinical practice within a school setting, and a satisfactory score on a state or national examination. Typically need a masters. The exact requirements to become a school SLP vary from state to state. o ASHA issues a Certificate of Clinical Competence in SLP (CCC - SLP) to an individual who has obtained a master's degree or doctorate in the field, completed a monitored clinical fellowship year, and successfully passes a national qualifying examination. o Individual states have licensure laws for SLPs that are usually independent of the state's department of education school certification requirements. A license may be needed if you plan to engage in private practice or work in a hospital, clinic, public school, or other setting. Most states accept a person with ASHA CCC- SLP as having met licensure requirements.

Speech

o Speech is the process of producing the acoustic representations or sounds of language. o Features such as articulation, fluency, and voice interact to influence speech production. The final product reflects the rapid coordination of movements associated with each of these features.

Speech Scientists

o Speech scientists may be involved in basic research exploring the anatomy, physiology, and physics of speech sound production. o Using various technologies, these researchers strive to learn more about typical and pathological communication. Their findings help clinicians improve service to clients with speech disorders. o Some speech scientists are involved in the development of computer - generated speech that may be used in telephone answering systems, substitute voices for individuals who are unable to speak, and fulfill many new purposes.

Clinical Elements

o Successful intervention is multifaceted and includes a variety of elements. o Treatment Plan - SLPs select what they believe and what evidence has shown to be the best intervention approach, types of materials, and logical steps to follow to take the client from where he or she is now to the objective selected. o Direct Teaching - Traditional clinical methods include explaining or reviewing the target and guided practice. - Behavior modification training approaches have been shown to be successful for a broad variety of communication disorders. It is a systematic method of changing behavior. During training, the SLP attempts to elicit the desired response from the client by providing a stimulus. The client is expected to respond, and the clinician reinforces this response if correct or provides corrective feedback if it is not. o Incidental teaching - The SLP follows the client's lead but teaches along the way. - The SLP manipulates the environment so that communication occurs more naturally. For ex: imaginary play with a young child or a cooking or art project with one who is older may serve as situations in which therapy occurs. o Counseling - An SLP can provide a supportive environment for the client and other key people in the client's life. A person with a communication disorder may experience a host of feelings including embarrassment, anger, depression, and inadequacy. - Family members may have similar emotions regarding the client's communication and may also feel pity or guilt, perhaps blaming themselves for the problem. o Family and Environmental Involvement - Depending on the family circumstances, family members may be asked to help the client with specific activities at home to foster carryover to everyday situations. - Support groups consisting of individuals who have similar difficulties often provide an avenue to practice what has been learned in therapy, to share feelings related to the disability, and to maintain communication skills once formal treatment has been terminated.

Successful treatment of voice and swallowing disorders

o Successful treatment of voice and swallowing disorders, laryngectomy (the surgical removal of the larynx), and cleft palate requires a thorough understanding of the anatomy and physiology of the speech mechanism.

Syntax

o Syntax pertains to how words are arranged in a sentence and to the way in which one word may affect another.

The Articulatory/ Resonating System

o The articulatory/ resonating system extends from the opening of the mouth to the vocal folds and comprises the oral activity, the nasal cavity, and the pharyngeal cavity o Together these three cavities form the vocal tract, which is a resonant acoustic tube that shapes the sound energy produced by the respiratory and laryngeal systems into all of the English speech sounds. o Structure important for speech production such as the teeth, tongue, and velum (soft palate) are housed within these three cavities.

Target Selection

o The assessment report should provide recommendations for long term goals and short term objectives for communication intervention. o The clinician, however, will have to decide which specific targets should be addressed and in what sequence.

Muscles of Inspiration

o The diaphragm is the principle muscle of inspiration - It is a domed structure - Composed of thin, flat, nonelastic central tendon and a broad rim of muscle fibers that radiate up to the edges of this central tendon. o The central tendon is in direct contact with each lung. o The diaphragm separates the thorax (chest) from the abdomen. o When the diaphragm contracts during inspiration, it pulls downward and forward, this enlarging the thorax. o In addition to the diaphragm, numerous thoracic and neck muscles contribute to inspiration.

Hyoid Bone

o The larynx appears to be suspended from the hyoid bone, a horseshoe shaped structure that serves as the point of attachment for both laryngeal and tongue musculature.

A little on the vocal folds

o The larynx houses the vocal folds, which are attached at the front near the midline of the thyroid cartilage and at the back to the arytenoid cartilages via the vocal ligament. When viewed from above, the paired vocal folds appear to be ivory - colored bands of tissue. They abduct (move apart) during respiration and adduct (move together) during voice production, or phonation.

Communication through the lifespan

o The most complex and challenging taks newborns face is learning the abstract code called "language" that those around them use to communicate. To do this, infants use first learn the rudiments of communication and begin to master the primary means of language transmission, called "speech" o The early establishment of communication between children and their caregivers fosters the development of speech and language, which in turn influences the quality of communication. This intricate pattern is fostered by physical, cognitive, and social development as a child matures. Language proficiency is critical to development of higher cognitive and social skills. o The process of elating speech and language is a social one that occurs through interactions of children and the people in their environment. o A young child uses a variety of speech cues and patterns to break continuous speech into more readily interpretable chunks. o Learning to become an effective communication is a dynamic and active process in which children in our culture become involved in the give and take of conversations. Even the more formal educational processes of learning to read and write are initially social and occur within early book-reading activities in the home involving children and caregivers. o Every person's speech and language continue to change until the end of life. Communication reflects the changes occurring in us and around us. Even means of communication can change (computers, cell phones, etc). o Languages change, too. New words and phrases have entered American English within your lifetime, such as Internet, Bluetooth, iPod, smartphone, texting, hiphop, and hybrid vehicle. o A competent communicator continues to adapt to changes in the language and in the communication process.

Abduction

o The posterior cricoarytenoid muscle is the primary muscle of vocal fold abduction (moving apart). Its action directly opposes the action of the lateral cricoarytenoid; therefore, these muscles are also agonist - antagonist pairs.

The Laryngeal System

o The primary biological function of the larynx is to prevent foreign objects from entering the trachea and lungs. o In addition, the larynx can impound air for forceful expulsion of foreign objects that threaten the lower airways.

The Respiratory System

o The primary biological functions of your respiratory system are to supply oxygen to the blood and to remove excess carbon dioxide from the body o This process is automatic, and is controlled by the respiratory centers located within the brainstem of the central nervous system o ALTHOUGH the primary function of respiration is to sustain life, it also serves as the generating source for speech production. o Air is inhaled into your lungs to become the potential energy source for sound production. The air is then expelled in a controlled manner, to be modified by your vocal folds and articulators to generate speech sounds.

Assessment goals

o The primary goal of diagnosis is determining the nature of the disorder. Sometimes diagnostic therapy is suggested. In this case, the SLP will work with the client for a time and will obtain a clearer picture of the person's communication abilities and limitations in the process. o An SLP provides data reporting the consistency of behaviors and, where appropriate, indicates how the client compares with more typical individuals. o If a problem exists, an SLP will want to describe its severity. o Although published tests often suggest severity ratings depending on a client's performance scores, these must be used with caution. There is a broad range of typical communication behavior, and an SLP should not rely overly on any single test. o Whenever possible, an SLP should try to ascertain the reasons (s) for the communication and/or swallowing deficit, especially if the cause persists. The cause is referred to as etiology. o There may be predisposing causes that underlie the problem, such as genetic factors, precipitating causes that triggered the disorder, such as stroke, and maintaining or perpetuating causes that continue or add to the problem. o Whether the etiology is known or not, an SLP must thoroughly describe the client's communication behavior. o In making a plan, the first decision is whether intervention is warranted. If it is, then its nature must be described. Treatment recommendations can be thought of as a "working hypothesis" that may need to be altered as intervention proceeds. o Assessment continues throughout treatment, in the forms of of data collection and probes of behavior. o An SLP obtains background information about a client from a written case history completed by the client, parent, or significant other; an interview; and reports from other professionals. o In communication disorders, an SLP makes a prognosis regarding whether the problem will persist if no intervention occurs and what the likely outcome is if a course of therapy or other treatment plan is followed. A prognosis is an informed prediction of the outcome of a disorder, both with and without intervention, and is based, in part, on the nature and severity of the disorder; the client's responsiveness to trial therapy during assessment; and the client's overall communicative, intellectual, and personal strengths and weaknesses. The clients home and school environments are also important factors that can affect the outcome.

Structures of the Laryngeal System

o The primary structure of the laryngeal system is the larynx, which is an air valve composed of cartilages, muscles, and other tissue. o It is the principal sound generator for speech production and is known as the "voice box". o The larynx sits on top of the trachea and opens up into the pharynx (throat). o The larynx appears to be suspended from the hyoid bone, a horse shaped structure that serves as the point of attachment for both laryngeal and tongue musculature. o The larynx consists of the thyroid, arytenoid, and cricoid cartilage connected to one another by ligaments and membranes.

Tongue

o The principle structure within the oral cavity important for speech production o The tongue is a muscular hydrostatic, meaning it has no bone or cartilage. It provides its own structural support through contraction of its muscles, but also has a "soft skeleton" of connective tissue that surrounds and separates its different components.

The Speech Production Process

o The production of speech begins with the sound produced by vocal fold vibration, or phonation. Phonation is initiated by approximating or adducting the vocal folds and closing the glottis or opening. Once the vocal folds are closed, air pressure generated by the respiratory system, called alveolar pressure, increases beneath the vocal folds. o The air pressure from below displaces the lower edges of each vocal fold laterally (apart). This is followed by lateral displacement of the upper edges of each vocal fold until the vocal folds are fully separated, opening the airway. Following max opening, the vocal folds' natural elastic restoring forces cause the lower edges od the folds to being to move inward toward the midline, followed by the upper edges, until the vocal folds collide with each other, closing off the airway. The entire process is repeated in a cyclical fashion at the average fundamental frequency of vibration, or the number of cycles per second. o The "Bernoulli effect", states that high air velocity through a narrow opening (the glottis) creates a negative pressure that sucks the vocal folds together; afterwards, air pressure builds up below the closed vocal folds and then blows the vocal folds apart; the process then repeats itself. We know now that the "Bernoulli effect" plays a very minor role in vocal fold vibration. o For each vibratory cycle the air in the vocal tract is set into vibration, and sound is produced. o The sound that results from vocal fold vibration is complex, consisting of a fundamental frequency, or the lowest frequency component that corresponds to the rate of vocal fold vibration and approx 40 additional higher frequencies called harmonics. The harmonic frequencies are whole number multiples of the fundamental frequency. o Relative intensity decreases systematically with increases in harmonic frequency o The vocal tract is an acoustic resonator that will modify the quality of the sound produced by the larynx. In any acoustic resonantor some frequencies are reduced or attenuated and other frequencies are enhanced, depending on certain physical aspects of the resonator. o Movement of the tongue, lips, and larynx will change the shape of the vocal tract, and in turn modify the sound emanating from the larynx. o A complex sound is produced by vocal fold vibration and the vocal tract acts as a filter attenuating some frequencies and enhancing others. o The sound that emanates from the mouth during vowel production is related directly to the general shape of the vocal tract determined largely by tongue position. o more info on sounds that I didn't include

Muscles of the Respiratory System

o The respiratory muscles are divided functionally into muscles of inspiration and muscles of expiration. o Inspiratory muscles are generally found above the diaphragm; expiratory muscles are located below the diaphragm. With the exception of the diaphragm, all respiratory muscles are paired (located on both the right and left sides of the body).

Grammar

o The rules of language make up its grammar.

Morphology

o The second aspect of form o Involves the structure of words Words contain both free morphemes and bound morphemes. o A free morpheme may stand alone as a word. For example, cat, go, spite, like, and magnificent are all free morphemes. If you attempt to break them into smaller units, you lose the meaning of the word. In contrast, cats, going, spiteful, dislike, and magnificently each contain one free morpheme and one bound morpheme. The bound morphemes -s, -ing, -ful, dis-, and -ly change the meanings of the original words by adding their own meanings. Bound morphemes cannot be used alone, and must be attached to free morphemes.

Glottis

o The space between the vocal folds

Space and Time - Proxemics - Tactiles - Chronemics

o The study of the physical distance between people as it affects communication is called proxemics. o Proxemics not only reflects the relationship between people but is also influences by age and culture. o Tactiles are touching behaviors. Who touches whom and how and where on the body the touch occurs can reveal a great deal. o Chronemics is the effect of time on communication. Again, cultural and age factors influence this aspect of communication. - People from German and Scandinavian backgrounds tend to be exactingly prompt, whole those from Latin and African cultures may permit greater time flexibility. o Status and context also affect chronemics. - You might be kept waiting at the doctor's office, but your doctor does not expect to have to wait for you. o Promptness is part of the US work ethic. if you are routinely late to class or to a job, you've violated a chronic norm and might have to pay a price in terms of a lowered grade or lost employment. o Age, sex, education, and cultural background influence every aspect of communication. o As we mature our communication changes.

Muscles of the Larynx

o The thyroarytenoid muscle forms the bulk of each vocal fold. This muscle extends from the angle of the thyroid cartilage to the arytenoid cartilage; contraction of the thyroarytenoid reduces the distance between the thyroid and and arytenoid cartilages, causing a shortening and thickening of the vocal folds. o The cricothyroid muscle directly opposes the action of the thyroarytenoid muscle, stiffening and lengthening the vocal folds; these muscles are therefore called agonist - antagonist muscle pairs. o The action of the cricothyroid muscle serves to increase vocal pitch, the perceptual correlate of fundamental frequency.

Thyroid Cartilage

o The thyroid cartilage is the largest laryngeal cartilage. It forms most of the front and sides of the laryngeal skeleton and protects the inner components of the larynx. o The upper part has a V- shaped depression called the thyroid notch. It can be felt by palpating the front of the neck. Just below this notch is a jutting protrusion called the thyroid prominence, or Adam's apple, which can be very prominent on some adult males.

Velum

o The velum, or soft palate, located in the pharynx, is an important structure for both speech and swallowing. The uvula is the termination of your velum. o When you breathe through your nose, the velum hangs like a curtain from the posterior aspect of the bony hard palate. During swallowing and speech production, the velum elevates and decouples (separates) the nasal cavity from the pharyngeal cavity, leading to velopharyngeal closure, or contact of the velum with the posterior and lateral pharyngeal walls. o Failure to separate these cavities during swallowing would result in food passing through the nasal cavity. o During speech production, velar elevation is necessary to prevent air from escaping through the nose and to allow sufficient pressure to build up in the oral cavity for production of pressure sounds (/p/, /b/). o Any air that escapes through the nose during speech can result in a nasal sounding resonance (quality).

Artifacts (in terms of nonverbal communication)

o The way you look and the way you have decorated yourself and your personal environment communicate something about you. o People make assumptions about our personalities and trustworthiness on the basis of our possessions, clothing, and general appearance.

Hard of Hearing

o They depend primarily on audition for communication o Hearing loss may be temporary due to an illness, such as an ear infection, or permanent, caused by disease, injury, or advancing age. o The severity differs o The loss may be conductive, sensorineural, or mixed. and it may be unilateral or bilateral o A conductive hearing loss is caused by damage to the outer or middle ear. o A sensorineural loss involves problems with the inner ear and/ or the auditory nerve. This type of damage is likely to affect a person's ability to discriminate and consequently understand speech sounds, although they may "hear" them. o Mixed hearing loss, as the name implies, isa combination of both conductive and sensorineural loss.

The role of the SLP in prevention

o This can be accomplished through education and the identification of potentially harmful and unhealthy situations, such as smoking and noise abatement. o Secondary to prevention is early identification and intervention to forestall more serious conditions. o To this end, SLP's take part in classroom education, community forums, wellness fairs, and counseling activities.

Augmentative/ alternative communication systems

o This is another communication variation. o This is not a communication impairment. o These systems, whether signing or the use of digital methods, are attempts often taught by SLPs to compensate and facilitate, on a temporary or permanent basis, for impaired or disabled communication disorders

Voice

o Voice can reveal things about the speaker as well as about the message. o A person with a hoarse voice might (correctly or not) communicate to others that she or he smokes. A person with a soft, high pitched voice might be communicating youth or immaturity. o Both the overall level of loudness and the loudness pattern within sentences and words are important. A generally loud voice may communicate strength; a soft one may suggest timidity. o By stressing different words within a sentence, you are also conveying different meanings. o Placing the stress on different syllables within certain words also changes the meaning. REcord vs reCORD. o As you vary the stress, the pitch, duration, and pronunciation of different speech sounds may also change. o The pitch tends to go up as the loudness is increased. o Similarly, you are likely to prolong the syllable that receive stress.

Disorders of Voice

o Voice matures as a child gets older o Although occasionally children are born with physiological problems that interfere with normal voice, more common is the pattern of vocal abuse o It is characterized by excessive yelling, screaming, or even occasional loud sining that results in hoarseness or another voice disorder. o Habits such as physical tension and excessive yelling, coughing, throat clearing, smoking, and alcohol consumption can disrupt normal voice production o These behaviors may result in polyps, nodules, or ulcers on the vocal folds where voice production begins. o Disease, trauma, allergies, and neuromuscular and endocrine disorders can also affect voice quality.

Deafness

o When a person's ability to perceive sound is limited to such an extent that the auditory channel is not the primary sensory input for communication, the individual is considered to have deafness. Deafness may be congenital or acquired. o Total communication, including sign, speech, and speechreading, is often considered the most effective intervention for deafness. Assistive listening devices (ALD), cochlear implants, and auditory training may be helpful.

Disorders of form

o o Language form includes phonology, morphology, and syntax. o An error in sound use, such as not producing the ends of words, constitutes a disorder of phonology. o This in turn, might affect morphology if a child omits the plural -s or the past tense -ed. o Syntactical errors include incorrect word order and run-on sentences. o Disorders of form may be due to many factors, including sensory limitations such as hearing problems or perceptual difficulties such as learning disabilities. o Limited exposure to correct models may also hinder a child's language development. o For many children who are delayed in their production of mature language forms, the cause is not apparent. o Neurological disorders caused by stroke or traumatic brain injury may result in a loss of access to language even though language remains intact. o An SLP must distinguish between dialectal or second language variations and disorders.