Praxis II (SLP), Missed Questions An Advanced Review of Speech-Language Pathology, 4th Edition: Practice Examinations questions, Praxis Advanced Review: 1, Praxis Advanced Review: 2

Jargon/1st words

11-14 mos. Greater variation in the sequences of syllables, creating so-called diverse babbling (e.g. ma-moo-mee); elevates tongue tip; intonational patterns; consistent forms (sound-meaning relationships); predominance of /m, w, b, p/; first words emerge - consist primarily of CV, VC, CVCV reduplicated, and CVCV patterns

Babbling

4-6 mos. Greater independent control of tongue; prolonged strings of sounds; more labial sounds; experiments with sound

Describe pharyngeal phase of swallow

:Swallow reflex triggered and bolus is carried through the pharynx. These simultaneous actions occur: (a) the velopharyngeal port closes; (b) the bolus is squeezed to the top of the esophagus (cricopharyngeal sphincter); (c) the larynx elevates as the epiglottis, false vocal folds, and true vocal folds close to seal the airway; and (d) the cricopharyngeal sphincter relaxes to allow the bolus to enter the esophagus

7 Extrinsic muscles of larynx

Digastric,Stylohyoid, Mylohyoid, Geniohyoid,Hypoglossus, Genioglossus, Thyropharyngeus

Surgical/medical tx to improve opening of pharyngoesophageal segment

Dilatation, Myotomy, Botox Injection

Characteristics of conduction aphasia

Fluent aphasia. Preserved comprehension with impaired repetition and literal paraphasias.

Wernicke's aphasia characteristics

Fluent but meaningless speech; severe auditory comprehension deficit; jargon, paraphasias, & neologisms; poor reading comprehension; writing deficits

Transcortical sensory aphasia characteristics

Fluent. Intact repetition, poor auditory comp, paraphasias

Functional aphasia assessment tools

Functional Communication Profile (FCP), Communicative Abilities in Daily Living (CADL), Communicative Effectiveness Profile (CETI), ASHA Functional Assessment of Communication Skills for Adults (ASHA-FACS

Non-neurologic causes associated w/ dysphagia

Head and neck cancer, GERD, esophageal tumors

HME device

Heat and moisture exchanger. Filter placed on tracheostoma which heats and humidifies air. laryngectomy)

Information-processing theory

Humans process the information they receive, rather than merely responding to stimuli. This perspective equates the mind to a computer, which is responsible for analyzing information from the environment

Mendelsohn Maneuver

Increased laryngeal movement stretches/opens the CP; Prolonging hyolaryngeal elevation keeps the CP open longer. used for 1) Decreased range/duration hyolaryngeal elevation; (2) Decreased range/duration cricopharyngeal opening; (3) Decreased pharyngeal swallow coordination

Supraglottic swallow

Patient holds breath and coughs immediatly following a swallow to close VFs before and during swallow. Used when there is reduced airway protection (at the vocal fold level); Aspiration DURING the swallow

Super-supraglottic swallow

Patient holds breath, bears down, and coughs immediately following swallow and immediately swallows hard again. Used when there is reduced airway closure; aspiration BEFORE and DURING the swallow

Nativist theories

Nature. Include Chomsky's transformational grammar (or generative grammar and the theories of Jerry Fodor and Eric Lenneberg. These theories view the acquisition of language as being based more on inherent abilities or mechanisms than on environmental influences

Stroboscopy

Most efficient & effective instrument for viewing the vocal folds (VFs)

Behavioral theories

Nurture. Such as Skinner's find language acquisition to be a form of operant conditioning in which linguistic behavior is shaped by the consequences of verbal responses.

Ventricular dysphonia

Patient adducts & vibrates ventricular bands instead or in addition to the vocal cords

Social learning theory

States that people learn within a social context. It is facilitated through modeling and observational learning

Surgical/medical tx to protect airway

Stents, laryngotracheal separation, laryngectomy, trach tubes, feeding tubes

Glottal fry

when VFs vibrate very slowly and the vibration causes a slow, low pitch vocal burst making the voice sound crackly or creaky, airflow rate and air pressure that produces the VF vibration are both low and lung volume is less

Head turn (to weak side)

blocks bolus from traveling down weak side by twisting the pharynx; applies pressure to the vocal fold to increase approximation; reduces resting pressure or the cricopharyngeus by pulling the larynx away from the posterior pharyngeal wall (increasing the space)used for unilateral pharyngeal weakness; unilateral laryngeal weakness; cricopharyngeal dysfunction

/p, m, h, w/ typically mastered

by age 3

/b, k, g, t, f, n/ and "ng" typically mastered

by age 4

/d/ typically mastered

by age 5

/l/ typically mastered

by age 6

Head tilt (to stronger side)

directs bolus to stronger side of oral/pharyngeal cavities used for unilateral oral weakness; unilateral pharyngeal weakness

Anomic aphasia (characteristics)

fluent aphasia, good comprehension & repeition. Word-finding difficulties, decreased output of nouns. Possible alexia & agraphia.

Transcortical motor aphasia location

frontal lobe; anterior and superior to Broca's area

Chin tuck w/ head turn

increases epiglottic deflection to narrow the entrance to the laryngeal vestibule; increases VF approximation by applying extrinsic pressure used for reduced airway closure

Blom-Singer

indwelling low-pressure voice prosthesis kit (laryngectomy)

Cooper-Rand

intraoral electrolarynx

Spastic dysphonia

involves aphonic breaks due to sudden over adduction or under adduction of VFs

Spastic dysphonia

overadduction of VFs = strained, choked, or creaky voice

Odynophagia

pain during swallow

Conduction aphasia (location)

path between sensory and motor speech centers (arcuate fasciculus) or insula or deep to supermarginal gyrus

Acute laryngitis

person may lose the use of voice and may become aphonic during episode. **not approriate to provide voice tx to these individuals

Piaget's stages

sensorimotor (birth-2yrs), preoperational (2-7 yrs), concrete operational (7-11 yrs), formal operational (11-18+ yrs)

Contact ulcers

stress, use voice extensively in daily life, has a tense, hard-driving personality, and exhibits glottal fry

Head back posture

used for oral transit dysfunction. gravity helps clear the oral cavity

Fiber-optic endoscopy

useful in assessing swallowing by providing direct observation of pharyngeal activity during the swallowing process

Emergentist theories

(e.g. MacWhinney's Competition Model) Such theories claim that language acquisition is a cognitive process emerging from the interactions of biology and the environment.

Reflexive vocalizations

0-1 months. Crying, coughs, hiccups, related to newborn's physical state

Cooing

2-3 mos. Sounds produced w/ a definite stop and start to oral movements. Back consonants and back and middle vowels w/ incomplete resonance

Canonical babbling

6-10 mos. Repetitive syllable production; increased lip control; labial and alveolar plosives /p, b, t, d/, nasals, and /j/ begin to emerge

deixis

A word (such as this, that, these, those, now, then) that points to the time, place, or situation in which the speaker is speaking.

Broca's aphasia characteristics

Agrammatism; effortful speech; short, telegraphic phrases; presence of apraxia; slow speech rate, lacking intonation; poor reading & writing ability; relatively good auditory comprehension

Nonfluent aphasias

Broca's, transcortical motor, global aphasia, mixed nonfluent aphasia

Esophageal phase

Bolus is transported through the esophagus into the stomach

Standardized aphasia tests

Boston Diagnostic Aphasia Examination (BDAE), Western Aphasia Battery (BAD), Minnesota Test of Differential Diagnosis of Aphasia (MTDDA), Multilingual Aphasia Examination (MAE), Porch Index of Communicative Ability (PICA), Aphasia Diagnostic Profiles (ADP)

Neurological causes associated w/ dysphagia

CVA, TBI, muscular dystrophy, Parkinson's, myasthenia gravis, ALS, MS, CP

Leading causes of aphasia

CVA, TBI, seizures, tumors, neurodegenerative disorders (dementia & primary progressive aphasia)

Postural tx methods for dysphagia

Chin tuck, head turn, head tilt, head back, chin tuck w/ head turn

Muscle with greatest control of fundamental frequency

Cricothyroid

7 Intrinsic muscle of larynx

Cricothyroid, Lateral cricoarytenoid(lateral), Posterior cricoarytenoid, Arytenoid, Thyroarytenoid,Aryepiglottis, Thyroepiglottis

Bulbar palsy characterized by

Flaccid paralysis

Describe oral preparatory phase of swallow (adults)

Food/liquid is manipulated in the oral cavity, chewed (if necessary), and made into a bolus, which is sealed with the tongue against the hard palate

Muscles of adduction

Lateral cricoarytenoid, transverse arytenoid

Muscle which opposes velopharyngeal closure

Lavator veli palatini

Global aphasia (common location of lesion)

Left MCA (entire perisylvian region)

Functional dysphonia

Likely results in no voice due to underadducted VFs.

Tx for dysphagia

Lip exercises, tongue exercises, jaw exercises, swallowing exercises

Surgical treatments to improve glottal closure

Medialization thyroplasty and injection of biomaterials

Sternocledomastoid

Muscle of respiration

Global aphasia (characteristics)

Nonfluent aphasia. Ranges from mutism to total repetitive jargon or neologistic output (fluent but incomprehensible speech). Poor comprehension & repetition

Characteristics of transcortical motor aphasia

Nonfluent. Intact repetition; lack of spontaneous speech; short, telegraphic sentences; agrammatism & paraphasias.

Broca's aphasia location

Nonfluent. Lateral frontal, suprasylvian, pre-Rolandic, extending into adjacent subcortical periventricular white matter

Incidence

Number of new cases of a disorder within a specified period of time

Bedside swallow exam

Obtain case history. Observe function of jaw, lips, tongue, phayrnx, larynx, and eating various textures

Ventricular phonation

Person uses false VFs- A rough type of phonation that, when used in conjunction with the true VFs, can result in diplophonia

Muscle of abduction

Posterior cricoarytenoid

Transcortical sensory aphasia location

Posterior parieto-temporal, sparing Wernicke's area

Wernicke's aphasia location

Posterior third of superior temporal gyrus

Empiricist theories

Recognizes the interaction between nature and nurture, but puts more emphasis on the role of learning, or nurture, and finds that the inherent, or nature, part is a general cognitive learning mechanism

Shaker Exercise & Mendelsohn exercise

Rehab swallowing exercises to improve function of strap muscles

Swallow maneuvers (not appropriate for those w/ cognitive deficits)

Supraglottic swallow, super-supraglotic swallow, Mendelsohn Maneuver, effortful swallow

Technique which results in temporary facilitation of swallow reflex

Thermal stimulation

Describe oral phase of swallow

Tongue moves food or liquid toward the back of the mouth (toward the anterior faucial pillars). To achieve this, the tongue presses the bolus against the hard palate and squeezes the bolus posteriorly

CNs involved in swallowing

Trigeminal (V), Facial (VII), Glossopharyngeal (IX), Vagus (X), Hypoglossal (XII)

criterion validity

Use external criteria- concurrent or predictive validity

Effortful swallow

Used to clear residue in valleculae. The increased effort increases the posterior movement of the base of tongue

Diagnostic tests for dysphagia

Videofluoroscopy, fiber-optic endoscopy, scintigraphy

Laryngeal web

Web grows btw VFs, usually triggered by mucosal surface laryngeal injury or irritation. Can cause severe dysphonia and shortness of breath but NOT total absence of voice

Fluent aphasias

Wernicke's, conduction, transcortical sensory, anomic

Piagetian theory

cognitive developmental theory which describes "ages and stages" components that predicts what children can and cannot understand at different ages, and a theory of development that describes how children develop cognitive abilities

Gastrostomy

creating an opening of a stoma in the stomach wall when normal food ingestion is not possible or ill-advised

Videofluoroscopy

e.g. modified barium swallow): a moving radiograph of the mouth, pharynx, larynx, and cervical esophagus during swallowing. can identify the specific nature of the oropharyngeal dysphagia; it can define abnormality of movements, trace progress of bolus, and demonstrate aspiration

Vocal nodules characteristics

hoarse voice quality, hard glottal attacks, and lowering of pitch

Vocal cord paralysis-vocal characteristics

hoarse, breathy, decreased vocal intensity, loss of pitch range

ProVox

low-resistance indwelling prosthetic (laryngectomy)

Laryngeal penetration

occurs when swallowed material penetrates laryngeal side of epiglottis, aryepiglottic folds, or spills over arytrenoid cartilages above level of true VFs

Scintigraphy

produces an image of the swallowing mechanism by first covering the vocal tract with a specific nuclide and recording the distribution of the radioactivity w/ a scanning external scintillation camera

Chin tuck

pushes base of tongue towards pharyngeal wall; expands vallecular recesses; narrows entrance to laryngeal vestibule by moving epiglottis posteriorly. Used for delayed onset pharyngeal swallow; reduced base of tongue retraction to posterior pharyngeal wall approximation; decreased airway protection; aspiration DURING swallow

1st choce for congenitally short palate

surgery

1st choice of tx for submucous cleft

surgery

Medialization thryoplasty

surgical procedure which moves the paralyzed vocal fold closer to the mid glottis to allow better compensation by the unaffected fold

Aspiration

swallowed material has entered the trachea below the level of the true vocal folds

Anomic aphasia (location)

tempo-parietal, angular gyrus; second temporal gyrus

Servox

transcervical electrolarynx