SLP Praxis Review

Recent increase in visibility of ax and tx of infants and toddlers due to:

Public law 99-457's incentives to identify and treat More medically fragile babies surviving due to medical advancements

External validity

Refers to generalizability of study's results to other subjects and situations

Midbrain (Brainstem)

Reflexes III, IV (Neither involved in speech)

Formant frequency

Region with concentrated acoustic energy

Continuous reinforcement

Reinforce all correct responses

Intermittent reinforcement

Reinforcement of only some responses

Differential reinforcement of incompatible behavior (DRI)

Reinforcing a desirable behavior that can't coexist with the behavior to be reduced Ex: sitting quietly/off-seat behavior

Differential reinforcement of alternate behavior (DRA)

Reinforcing a specified desirable alternate behavior to a undesirable behavior Ex: ask instead of whine

Adolescent Ax

Screening Case hx Social ax (parents, teachers, peers) Eval, syntax, smectics, morphology, pragmatic receptive and expressive lang Eval reading and writing

What is phonology?

Study of how speech sounds of a language are classified and organized (Hodson's)

Applied (clinical) phonetics

Study of practical application of research in articulatory, perceptual, acoustic, and experimental phonetics E.g. phonetic analysis

Acoustics

Study of sound as a physical phenomenon

Articulatory or physiological phonetics

Study of speech sound production (physiological movements)

Phonetics

Study of speech sounds Physical, physiological and acoustic properties

Morphology

Study of word structure Morpheme= smallest meaningful unite of a language (divided any further they become meaningless)

Van Riper - two approaches, stuttering, articulation

Stuttering - (not the medical model) - make stuttering less abnormal, does not focus on 'correct fluency' Articulation - traditional - motor-based; stimulus bases; progress from word to conversation, does focus on 'correct articulation'

Operant behavior theory

Stuttering changes if *consequences change* Response-contingent electric shock or noise, time-out, response cost

Cerebral dominance theory

Stuttering is thought to be caused by lack of a unilateral dominant hemisphere

Consistency effect

Stuttering on same word/loci when passage read aloud repeatedly Stimulus-response phenomenon About 65% of stuttering in an individual's speech may be this effect

Artic errors Korean CLD

Sub: a/ae FCD, confusion r/l Devoicing voiced cognates Shorten polysyllabic words Omit r

Dysphagia lusoria

Subclavian artery (at aortic arch) externally compresses esophagus

Extrapyramidal composition

Subcortical nuclei: red nucleus, substantia nigra, subthalamus, basal ganglia, and their pathways

Sympathetic nervous system

Activates fight or flight response

Transverse arytenoid

Adductor X RLN

Lateral cricoarytenoid

Adductor of vocal folds *Increase medial compression* Closes airway X RLN

Typical language-learning ability: Adequate background

Adequate background May need: -Bilingual education -Sheltered English -Instruction in ESL

Langauge Impairment: Adequate background

Adequate background May need: -Bilingual special education -English special education with as much primary language input/teaching as possible

Soft palate fuses in utero

10-12 weeks Knits together last If only a small cleft, it will be in this posterior section

Air-bone gap

10dB or more between bone- and air-condition thresholds

External intercostals

11 pairs Elevate ribcage Increase diameter thoracic cavity Inspiration

Sensorimotor substage 2

2-4 months -*Coordinated* hand-eye movements -Coordinated hand-mouth movements

Pre-operational Preconceptual substage

2-4 years -Egocentric -*Overextends, underextends* word meanings

Amount liquid a 1-mo-old consumes at a feeding

2-6 oz

Code switching

Alternation 2 languages Word, phrase or sentence level Natural bilingual behavior

Cicropharyngeal Myotomy

CP muscle split top to bottom to create permanent open sphincter for swallowing

CRANIAL NERVES (cont. pg. 25-56)

CRANIAL NERVES- *confirmed*

Integral stimulation method

Milisen (1950's) Imitation, auditory and visual models Ex: 'watch and listen to me'; 'say it with me'

Sensorimotor substage 5

12-18 months (object permanence, object function, walk, imitate) -*Object permanence* becomes evident -*Walks* with confidence -*Imitate* other's behavior if person present -Experiments with *object function*

Pre-Operational Piaget Stage

2-7 years -Uses symbols (words and images) to represent objects -Does *not reason logically* -Ability to *pretend*/animates inanimate objects -Can talk past here and now, into 'past, future, feelings'

Halliday functions

"Children are motivated to learn language because it serves a purpose" From 9-18 months *Instrumental* - to obtain assistance for wants (want juice) *Regulatory* - tell others what to do (go away) *Interactional* - initiate connection (hi daddy) *Personal* - express feelings, identity (yummy food) *Heuristic* - gain knowledge about world (why/what that?) *Imaginative* -pretend play *Informative* - communicate experiences (want to tell you smthg) These functions give way to generalized 'metafunctions' adults ahve as child language matures

Wedge approach

(Sommers and Kane 1974) Targets selected based on dissimilarity Assumption these will transfer Can be used on preschoolers since sounds are so different Used all settings & with all ages Suited for those with several misarticulations

Phonological processes eliminated by age 3

(These apparantly are eliminated normally in this order): Reduplication Weak syll deletion Final consonant deletion Consonant assimilation Fronting of velars Diminutization

Cleft of prepalate and palate

(any combination of clefts of the prepalate and palate)

Cause of aspiration in esophogeal phase

(post swallow phase) Accumulated residue in pharynx (valliculae or pyriform recesses) and then inhaled when breathing resumes after swallow

VF hemorrhage

* Sudden onset Severe hoarseness at sporting event

Disorders of resonance Assimilative Nasality

Nasal consonants carry over to adjacent vowels Velar opening begins too soon and lasts too long Functional or organic

Gavage feeding

Nasogastric tube for infants

Semantic relations in 1 word utterances

*AALENDRRP* Attribution - Adjective; e.g. big Action - Request or label action; e.g. open Locative action - Change in location; e.g. up Existence -Attends to item in presence; e.g. that? Nonexistence -Present but disappeared; e.g. no, all gone Denial - Denies statement; e.g. no (not kitty) Rejection - no (bath) Recurrence - Happens again; e.g. more Possession - mine

*Boyle's law*

*At a constant temperature, air volume and pressure are inversely related*, and their product is a constant. When thorax expands, air volume inside the lungs increases, causing air pressure to decrease. *Air flows from high pressure areas outside the body toward low pressure areas inside the lungs, how we inhale.*

Hypokinetic dysarthria

*BG*/extrapyramidal damage *High* *tone*, *rigidity* and *reduced* *ROM* *Tremors* face limbs at *rest* *Mask-like* face Small writing Excess saliva/*decr* *swallowing* *Monopitch*, low pitch, harsh/breathy voice Imprecise *C* Irregular breathing *Parkinson's* - too much inhibition BG Clue: Think Parkinson's; Think LSVT

Hyperkinetic dysarthria

*BG*/extrapyramidal damage Abnormal extraneous movements, face too Myoclonus (involuntary jerks, etc) *Distonia* due to contractions of antagonistic muscles causing abnormal posture *Voice* *tremor*, strained, harshness, *stoppage* Resonance hypernasality Slower speech *Inconsistent* articulation, prosody and vowel duration fluctuations *Huntington's* - lack of inhibition BG (similar writhing as in Athetoid CP)

Ataxic dysarthria

*Cerebellum* Gait disturbances Incoordination in articulation and prosody *Inaccurate*, *low* *tone*, tremor, monoloudness, harshness, *drunken* *speech* quality Under/overshooting *Irregular* *AMRs* *SMRs* *Strangled* voice, *variation* in loudness

Simple harmonic motion

*Back* *and* *forth* movement of particles with symmetrical and periodic Sine wave Tone of single frequency that repeats itself

Esophageal manometer

Catheter passed through nose/throat Pt swallows various volumes of saline Pressure sensors help diagnose weakness/obstructions in throat/esophagus (not for oral prep stage!) (not sure if SLPs do this)

*TBI Tx* - two main areas

*Cognitive rehabilitation* - attn, visual processing, mem, reasoning skills *Communication treatment* - involves comm partners and pt, reinforce: attending behaviors, appropriate discourse, topic maintence, self-correction; must be functional

Frontotemporal dementia associated w Pick's disease

*Dense intracellular formation in neuronal cytoplasm*, inflated neurons Progressive loss vocabulary, paraphasias, circumlocution, lang problems Uninhibition, inappropr behavior, impaired judgment, depression Key: Spared memory/orientation

*Otalgia*

*Ear pain*

Tx Infants with HI, timeframe

1-3-6 1: screening 3: Retest 6: Enrolled/fitted

Trisomy 13

*Extra 13th* chromosome 47 instead of 46 chromosomes Severe birth defects: clefts, extra fingers/toes Often heart, brain or spinal abnormalities Short life span

Infant toddler ax guidelines

*Family* *centered* ax *Team* approach Interviews, case hx, culture, child rearing, roles Assess: *Language* related skills Language comp and verbal comm *Infant-carefigver* interaction *Play* activities- Solitary play (2-3), parallel play (mimics but doesn't engage with peers), associative play (more interested in peers than toys), cooperative play (organization; 4 years old)

Semantic bootstrapping

Pinker Idea that children *use the meaning* of known words to discover the structures of language they are in process of acquiring

Formal operational Piaget Stage

12-adult (POV, abstract reasoning, if...then, hypothetical) -Decreasing egocentricity, sees other pts of view -Think and speak in *abstract* -Inductive and deductive reasoning -If...then statements -Can use *hypotheses*

Sensorimotor substage 6

18-24 months (words, thought, cause-effect, symbolic play) -Uses words when referents not present -Uses thought to solve problems -Acquires basic *cause-effect* understanding -Uses *symbolic play*

SSA

1935 - Social Security Act Federal health care Medicare and medicaid foundation established

*Otomycosis*

*Itching and some HL*

*Closed head vs open head* injuries

*Key criteria: state of meninges* If penetrated, it's classed as 'open'. Closed head has primary and secondary brain damage due to acceleration and deceleration forces

Flaccid dysarthria

*LMN* (CN's motor units) Cause: MG, botulism, Vascular disease, brainstem strokes, infections (polio, sec to AIDS), ALS, progressive bulbar palsy, surgical trauma *Weak*, low tone, *fasciculations* *Breathy* voice, audible inspiratin, short phrases *Hypernasality*, imprecise *C*, *nasal* *emission* Harsh voice, mono pitch *Articualtion* *disorders*

3 Major Medical Tx for Carcinoma

*Laryngectomy*: surgery to remove larynx; total or hemilaryngectomy Radical neck dissection: lymphatic system also removed Laryngectomee= person who has had larynx removed *Chemotherapy*:Used alone or with other measures *Radiation* therapy: alone or combined with surgery; used before surgery to eliminate cancer; side effects= skin burns, edema, swallowing probs, diminished taste, sore throat, xeristoma

Abdominal muscles that assist in exhalation of lungs

*Latissimus* *dorsi* (stabilizes posterior abdominal wall) Rectus *abdominus* (flexes vertebral column) Following compress abdomen: Transversus *abdominus*, Internal oblique *abdominus*, *Quadratus* *lumborum*, *Internal* *intercostals* (Parasympathetic nerve fibers)

Microtia

Pinna very small and deformed Congenital underdevelopment Cond HL

Amplitude

*Magnitude* and direction of displacement Strength or magnitude of sound signal Greater the amplitude, the greater the sound signal Related to intensity

Causes of SNHL

*O*toxic drugs (reach inner ear through blood stream) *N*oise (often results in HL between 3000Hz and 6000 Hz) *B*irth defects (STORCH) *A*coustic neuroma *M*eniere's disease (results in tinnitus)

Palatal shelf surgery

*Obdurator* Allows for nasal breathing For non-nasal sounds, pharyngeal walls can push up to obdurator to close VP

*Rochester* method approach for HI communication

*Oral* speech and *fingerspelling* *No signs* Traditional English for oral

Muscles that lower the velum

*Palato*glossus (elevates and depresses, also elevates tongue) X XI *Palato*pharyngeus (also narrows pharynx, may help elevate larynx) X XI

Public law 94-142

1975 - FERPA (later retitled IDEA) Family Educational Rights and Privacy Act All children 3-21 receive free and appropriate education in LRE, development of IEPS, government must fund services

*Direct stuttering reduction* models

*Pause-and-talk (time out)* Client taught to pause talking after each dysfluency, then resume *Response cost* (get a token for fluency, remove for dysfluency) *Indirect* - parents slow speech, etc

Infant *pragmatic* development

*Perlocutionary* - infant 'signal' have effect on caregiver yet *no comm intent* (unintended smiling evokes response) *Illocutionary* - 9/10 mo - *comm intent* in actions like *pointing* *Locutionary* - 12 mo - *words* *Joint reference* - ability to *focus* on object as *directed by other person*

Public law 99-457

1986 - Amendments to 94-142 Increased support for EI, development of IFPS, multidisciplinary stressed, svs providers must attains state's highest requirements, no longer required to report preschool kids by disability

Overall *extrinsic* tongue muscle functions

*Position* the tongue: Genioglossus (XII)- protrude and press, retract, draw down and anteriorly Styloglossus (XII) - up and back Palatoglossus- muscle of velum, elevate tongue Hyoglossus (XII) - retract and depress Chondroglossus (XII)- depresses

*Fluency Reinforcement* Method

*Positively reinforce* fluent speech in naturalistic conversational contexts Works with *younger children*

Oral preparatory phase disorders

*Probs* *chewing* *food*- reduced tongue ROM, reduced mandibular ROM, reduced buccal tension, poor alignment of mandible and maxilla *Probs* *forming* and *holding* *bolus*- food slippage into sulci- aspiration before swallow due to weak lip closure, reduced tongue movement, inadequate tongue and buccal tension

IDEA

1990 - Individuals with Disabilities Education Act free and appropriate public education in the LRE "handicap" term changed to "disability" More categories, more parent involvement, alternative access stressed

Pharyngeal phase

*Reflex* actions Reflexes triggered by contact food makes with anterior facial pillars Velopharyngeal closure, laryngeal closure (elevated larynx to seal airway, reflexive relocation of cricopharynxgeus muscle for bolus entry, & reflexive contractions of pharyngeal constrictors to move bolus down and to esophagus)

*Eustachian tube in infants*

*Shorter and more horizontal* than adults Tensor veli palatini less developed, so tube more easily open

*Blissymbols*

*Semi iconic*, abstract *Can be taught to CLD* populations

ADA

1990-Americans with Disabilities Act (P.L. 101-336) Civil rights protection for employment, svs, telecommunications, public accomodations to those w disabilities, no discrimination in employment, special equipment must be provided to workers w disabilities

3 types OM

*Serrous*: inflammation, watery or thick fluid, e tube blocked, tm vibrates ineffectively, cond HL Tx: anitbiotics, PE tubes *Acute*: sudden onset from infection, fever Tx: myringotomy *Chronic*: permanent damage in middle ear, TM ruptured Tx: myringoplasty

HIPAA

1996 - Health Insurance Portability and Accountability Act Federal privacy standards Protects Pt personal health information Involves healthplans, hospitals, doctors, health-care providers

Overall *instrinsic* tongue muscle functions

*Shape* the tongue: Superior longitudinal (XII) - shortens and curls tip and sides Inferior longitudinal (XII) - shortens, pulls down, retraction Vertical (XII)- flatten Transverse (XII)- narrow and elongate

Brown's morphemes

*Stage* *I* - MLU 1.75 - Semantic relations *Stage* *II* - MLU 2.25: ~20-30 months 1: -ing ... (19-28 months) 2-3: in on ... (27-30 months) 4: -s (24-33 months) *Stage* *III* - MLU 2.75: ~25-40 months 5: irr past .... (25-46 months) 6: 's.... (25-40 months) 7: uncontractable cop.... (27-39 months) e.g. here IT IS; there I AM *Stage* *IV* - MLU 3.5: ~ 26-46 months 8: a/the .... (28-46) 9: -ed ..... (26-48) 10: 3ps -s (26-46); e.g. daddy cook*s* *Stage* *V* - MLU 4.0: ~30-50 months 11: irr 3p.... (28-50); e.g. does, has 12: uncontractable aux .... (29-48) 13: contr cop..... (29-49) 14: contrbl auxiliary (30-50)

STORCH

*Syphilis, Toxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex* Major causes *HL in fetus/infant*

Bilateral choanal atresia

Choanal = posterior naris Congenital condition Back nasal passage blocked Infant serious breathing probs

Spastic dysarthria

*UMN* *bilateral* After acute illness *Jerky*, *stiff* movements *Slowness*, *prolonged* vowels, *equal* *stress*, slow rate Imprecise *C* and *V* Breathy, *harsh* voice, low ptich, *strianed/strangled* quality, *hypernasality* *Hyperadduction* of VFs Hyperactive *gag* reflext

*Myoelastic Aerodynamic* theory

*Van den Berg's* theory VF's vibrate because of the forces of air pressure and elasticity VF's build subglottic pressure, they are blown apart, rushing air makes low pressure zone between edges of VFs, which sucks folds back together

Ax procedures SSD

Conversation speech samples Evoked speech samples (imitation, naming, sent complete) Stimulability Standardized tests Independent and relational (after 50 wds) analysis (relational compared to adult target)

*Pic symbols*

*White drawing on background*

Internal intercostals

Depress ribcage Decrease diameter thoracic cavity Exhalation

Scope of Practice

+ memory, cognition, counseling, sensory awareness training related to swallow, articulation, language, feed infants - esophageal-phase swallow, prescribe hearing aids

*Assistive Devices* for Hearing Impaired

- *Safety* alerting devices--> help people with hearing impairments to gain info through flashing lights or vibrators on common devices. - *closed captioning*--> help people who are deaf know what is happening in the TV program - *telecommunication* devices for the deaf (TDDs) --> allow people who are deaf to use the telephone. Portable terminal that both sends and receives *typed messages via telephone*.

Evaluation of Swallowing Disorders

- An ultrasound examination can measure oral tongue movement - A manometric assessment can assess the preparatory phase of the swallow using posterior and lateral plane examination - An electromyographic assessment can be conducted by attaching electrodes on structures of interest (e.g., oral, laryngeal, or pharyngeal muscles) - A videofluorographic assessment (modified barium swallow) can be conducted to evaluate oropharyngeal swallow involving lateral and anterior-posterior (A-P) examination

Evaluating CLD individuals

- Use a dynamic assessment model to evaluate the individual 's language-learning ability and combine this with classroom observations over the next two to three months to evaluate his/her progress

Sensorimotor Piaget Stage

0-2 years -Explore world via sensory and motor contact -Object permanence and separation anxiety develop -Egocentric Divided into 6 substages

Duration normal pharyngeal swallow

1 second

Mnuemonic for Brown's morphemes grouped by stage

1- no morphemes just semantic relations (12-26 mo) 2 - putt*ing* food *on* and *in* dishe*s* (27-30) 3 - *hid* Dad*'s* hat, *is he mad*? (31-34 mo) 4 - *the* man bik*ed* there, he bike*s* daily (34-40 mo) 5 - he *does*? *is he coming*? *he's mad*, *he's coming* (40-46+ mo) 4 clues: food / hat / bike / mad

Examples Brown's morphemes

1. present progressive ing 2/3. prepositions in and on 4. regular plural inflection s; my crayonS --------------------- 5. irregular past tense verbs; came, ran, sat, broke 6. possesive s; daddy'S hat 7. uncontractible copula; here IT IS, there I AM (can't say "here it's") ------------------ 8. articles; a, the 9. past tense regular ed (26-48 mo) 10. regular third person; daddy cooks, kitty meows ---------------- 11. irregular third person; does, has 12. uncontractible auxiliary; she WAS working (can't be "she's working" and have same meaning) 13. contractible copula; he IS nice can be HE'S nice 14. *contractible auxiliary - last*; dad IS coming can be DAD'S coming

Brown's MLU and ages

1.31 - 18 months (1 yr 6 mo) 1.92 - 24 months (2 yr) 2.54 - 30 months (2 yr 6 mo) 3.16 - 36 months (3 yr) 3.78 - 42 months (3 yr 6 mo) 4.40 - 48 months (4 yr) So...MLU of 4 = 3 yr 8 mo 6.0 (6 yrs) and adult like language Note: feet, drove = each 1 morpheme

Order and age of sound acquisition

1.5-3....p m h n w 1.5-4....b 2-4.......k g d 2-6.......t ng 2.5-4....f, y 3-6........r, l 3-8........s 3.5-7.....ch, sh 3.5-8.....z 4-7.........j 4-8........v 4.5-7......th 5-8.........TH

Complex tone

2 or more single-frequency tones are combined Contains periodic or aperiodic waves

Intelligibility by age

2 years - 60-70% 3 years - 75-80% 4 years - 90-100% (Bernthal)

Normal ear of young adult can respond to

20-20,000 Hz

Typical development 2-3 years

200-600 words expressive; avg 425 at 30 months; 3600 words receptive at 36 months Word combos 3-4wd sentences Negations Wh-questions Plurals Morphemes: ing, in on, -s, irregular past-tense Telegraphic speech (object-verb, verb-object, subject verb) Maintain topic 20% of time MLU: 2-4

Public law 108-446

2004 - updated IDEA Individuals with Disabilities Education Improvement Act end of 3yr authorization process, findings of excellence in spec ed, emphasis on pre-referral svs to prevent unnecessary referrals

Linguistics has how many areas of study?

3 - Meaning, context, form (according to one praxis practice question)

Pragmatics has how many major communication skills?

3 - Using languaging, changing language, following rules (according to one praxis practice question)

Pharynx

3 segments: laryngopharynx: (add resonance)immediately superior to larynx ends at base of tongue; connected to... oropharynx: (add resonance)extends up to soft palate nasopharynx: (add resonance to /m/, /n/ and /ng/) ends where the two nasal cavities begin

*Glasgow Coma* scale

3 to *8*: severe 9 to *12*: moderate 13 to *15*: mild Behaviors: *eye* opening (1-4), *verbal* response (1-5), *motor* response (1-6)

Corticospinal tract

Descend from motor cortex through the internal capsule, continue through midbrain and pons (UMN) Decussate at the medulla, 80-85%, causing contralateral control After medulla they are LMN but no longer corticospinal tract

Direct Tx vs Indirect Tx

Direct: Food or liquid is placed in mouth to shape appropriate swallowing Indirect: Does not involve food

Pre-operational Intuitive substage

4-7 years (Egocentric, concrete, lack conservation) -Egocentric -*Concrete* thought (5 $100 bills seem more than 1 $500 bill) -Perception guides thoughts -Deals one variable at a time -Improving classification skills, still inadequate -Lack of conservation (roll play dough into different shape, thinks it is a different amount)

Sensorimotor substage 3

4-8 months (objects, babble) -Acts on *objects*, searches for objects -Imitates some sounds, *babbles*

Average max phonation time

3/4=7.5-8.95 seconds 5-12=14.97-17.74 seconds Adulthood= 20.9-24.6 seconds Geriatric=14.2-18.10

Adults have how many teeth

32- 16 in each arch

Language probs neglect, abuse

4 children die daily due to neglect/abuse (NA) Co-occur with physical/other disabilities Affect on language depends on severity Mother reluctance for reciprocal interactions with infants Child frequently isolated so little language exposure: underdeveloped social, rec, exp lang; exp lg delays Tx: multidisciplinary (emotional, parental needs)

Spinal column

7 cervical vertebrae (C1-C7) 12 thoracic vertebrae (T1-T12) 5 lumbar vertebrae(L1-L5) 5 sacral vertebrae (S1-S5) fused in adults 3-4 coccygeal vertebrae (fused and called the coccyx)

Concrete operational Piaget Stage

7-12 years (POV, conversation, logic, classification) -Starts seeing *other's point of view* (less egocentric) -Begins serial and conversation skills -*Employs logic* (add, subtract) -Effective *classification* skills

CNs that exit medulla

8-12

Sensorimotor substage 4

8-12 months (*walk, 1st word, search, move*) -Starts walking, uses first word -Searches for objects from memory -Begins to realize can cause objects to move

Hard palate fuses in utero

8-9 week Three pieces move to midline at this time: maxilla and two palatine bones

Parkinson's disease

94% have hypokinetic dysarthria Reduced loudness, breathy voice, monopitch and monoloudness, intermittent and rapid rushes of speech, imprecise articulation, forced inhale/exhale that interrupts speech Palilalia

Adult male vital capacity

4L to 5L

Dx of stuttering when rate is

5% of words spoken are dysfluent

Lip closure in utero

5-6 weeks If premaxilla isn't in place in time, then cleft lip, right, left or both.

Conversational speech samples

50-100 utterances of connected speech

Normal speech range in dB SPL Airplane dB Painful hearing at what dB SPL vs HL

50-70 dB SPL 100 dB SPL Pain at 140 dB SPL Sound pressure level / hearing level HL for audiometers, pure-tone testing

Transcortical Motor Aphasia

Anterior superior frontal lobe (lang dominant hemisphere) - fluent + aud comp + repeat (Impaired spontaneous speech; Nonfluent, paraphasic, agrammatic, telegraphic; Echolalia/perseveration; Impaired writing; *Good* *comprehension*;*Intact* *repetition*)

Parametric statistics

A branch of statistics which assumes that sample data comes from a population that follows a probability distribution based on a fixed set of parameters. More precise.x

Assimilation

Feature of one phoneme affects change of that feature in nearby phoneme (example great zoo -> gret soo due to voiceless t in great)

Hearing aid fitting and orientation

A focus of contemporary hearing aids over previous focus on auditory training and speech reading

Suprasegmentals

Features of prosody Length, stress, rate, pitch, volume, and juncture (vocal punctuation)

*Metrical* pacing

For AOS. Uses computer-generated pacing tones to keep *natural rhythm without slowing* (not per syllable)

Wet spirometer

A spirometer that uses liquid to measure exhalation volume

Nonparametric statistics

A statistical method wherein the data is not required to fit a normal distribution. Often used ordinal data. Good for ranks. Inferential.

Cued speech

A system used by Speaker for HI person Produces manual cues to represent sounds spoken Uses 8 signs for consonants and 4 for vowels Increases correct speech reading from 30 to 84%

Vocalization

A vowel is substituted for a syllabic consonant (apple to apo)

NonLinear theory of phonological development

Alternative to linear phonology theory -Accounts for stress and tone -Focus on prosody -Units of different sizes -Assumes some hierarchy -Biggest contribution: organizing therapy, attn on multisyllabic words -Accounts for lg acquisition stages by positing order goes from least to most specified

AAC SECTION (PG. 171-173)

AAC SECTION *confirmed*

Inheriticance of: Autosomal dominant Autosomal recessive

AD: 1 parent, mom or dad AR: both parents (if 1 parent child can be carrier)

Depalatization

Alveolar affricate for a palatal affricate (or fricative) Ex: Wats for watch

Johnson

Avoidance behavior This researcher believed stuttering *caused by avoidance* behaviors *Diagnosogenic* theory that avoidance behaviors develop when parents punish normal dysfluencies trying to avoid this punishment

Description of language disorders in adolescents Syntactic problems

Limited length of sentences Difficulty with complex sentences Difficulty with cohesion Lack of agreement (e.g. verb-noun agreement) Persistent use of syntactic errors Limited use flow-freq. structures

Narrative skills training technique

Act out, scripts, video modeling, peer-training, routinized daily activities, repeat read stories w fill-ins, child re-tells, child narrates new events, plus direct teaching

APHASIA SECTION (PG. 321-338)

APHASIA SECTION- *confirmed*

ARTICULATION, PHONOLOGY, THEORY SECTION

ARTICULATION, PHONOLOGY, THEORY SECTION

SLP licensing

ASHA CCC's not needed for all states for schools, but is needed for some; license is needed for most states; both are needed in most states for health care ASHA CCC's do not have the legal authority that state licensing has State education department's credentials are not the same as those of state's licensure Most state licensure requirements are automatically met when a graduate student meets ASHA standards for certification

ASHA and INSURANCE RELATED SECTION (pg. 595-end)

ASHA and INSURANCE RELATED SECTION

AUDIOLOGY SECTION (CHAPTER 10- PG. 435-478)

AUDIOLOGY SECTION- *confirmed*

Posterior cricoarytenoid

Abducts vocal folds Opens airway (X RLN) *Only vf abductor*

Percent stroke survivors who experience aphasia

About 50%

Diencephalon (Brainstem)

Above midbrain between brainstem and cerebrum Contains thalamus (regulates incoming sensory; relays motor info) and hypothalamus (integrates automatic nervious system, controls emotions)

Cri du Chat syndrome

Absence of short arm of chromosome *5* one symptom is meowing like a cat, high pitched cry 5% or less chance of second child having

Premack

Abstract plastic shapes representing word or phrase

Phonemic

Abstract system //

Focus lang tx

Academic and social language, needed for success in school environment and to be socially competent

Acculturation vs Assimilation

Acculturation: Immigrants assume American cultural attributes Assimilation: Incorporation into cultural and social networks of host society

Tx considerations for CLD children

Acknowledge cultural, linguistic backgrounds Support development both languages Focus on developing vocabulary skills Promote effective communication with peers Incl rdg, wrtg, listen, talk; always literacy Relate to class curriculum and CORE Build relevant cognitive processing skills (increasing processing speed)

Impedance

Acoustic, mechanical or electrical resistance to motion or sound

Breathing rates

Adult at rest - 10-25/min

Fundamental freq range

Adult male: 100-150 Hz Adult female: 180-250 Hz Infant: up to 600 Hz ? Geriatric female: 201 Hz, male: 132-146 Hz

VF length

Adult male: 17-25 mm Adult female: 12.5-17.5

Incidental teaching technique

Adult waits for child to initiate verbal response Pay full joint attn to stimulus that prompted chd response Prompts or models elaboration response Praises child, gives object when child elaborates

Newborn development specialist

Advanced practice role for SLP May serve as primary care coordinator or case manager for medically fragile infant and family Created ax and intervention strategies 1.Feeding and oral-motor development 2.Hearing conversation and aural habilitation 3.Infant development and behavior 4.Caregiver-child communication

CP in children

Affected nervous system resulting in motor difficulties Ex: orthopedic abnormalities, seizures, feeding, HL, perceptual diff, ID, but not all have all of these Dysarthria common Some have language deficits also Tx: multidisciplinary team, AAC

Subcortical aphasia syndromes

Affecting articulation: anterior capsular posterior capsular global capsular thalamic NOT: malleus capsular

Significant aperiodic speech sounds

Affricates Whispers Hoarse voice

Speech, voice, rhythm Tx focus

Affricates, fricatives, stops Voice-horse/harsh Resonance- hypernasality/hyponasality Can use Visi-Pitch

TTR

Age 3-8 - .5

Age most sounds acquired in English

Age 7 Not: 5, 9 or above Can produce all sounds but may still be working on phonological acquisition Also, age 7 can produce 50 English morphemes (bound?)

Adoption considerations

Age of adoption=critical Before 12 months= normal language development Toddlers= rapid, but not the same as peers Lang skills should be Ax immediately upon arrival and at regular intervals after Language attrition of L1 is rapid- underdeveloped L1 to begin with Rec English more rapid than Exp English Social pragmatic lang may need more focus

Inverse filtering

Method of subtracting nonlaryngeal acoustic features from a signal to a simple form revealing VF production

Recurrent laryngeal nerve (RLN)

All *motor* to remaining intrinsic laryngeal muscles (interarytenoid, posterior cricoarytenoid, thyroarytneoid, and lateral cricoarytenoid muscles) All *sensory* to below VFs RLN can be damaged in thyroid or heart surgery resulting in VF paralysis

*Misconceptions* about AAE

All African Americans speak AAE AAE is spoken only by African Americans AAE is a substandard form of MAE AAE is not regular and predictable Children's use of AE must be discontinued Use of standardized language tests are a nonbiased indicator of language knowledge and skill

Thalamus function

All ascending sensations pass through on way to brain except olfactory; Relays motor info

Interpleural space function

Allow lungs to contract and expand without friction

Simultaneous strategy

Also called Horizontal Ex: rec and exp lang both in one task and addressing more than one aspect child's language deficits

Sequential strategy

Also called Vertical Target each phonological process in each session set Ex: 1st 3 wks - listen, repeat 2nd 3 wks - watch, imitate 3rd 3 wks - articulate fricatives and affricates

Progressive assimilation

Also called consonant harmony Earlier occuring sound influences later sound Ex: kick for kiss

Parietal lobe

Also called the sensory cortex- somesthetic Supramarginal gyrus- Damage= Conduction, agraphia (writing disorder) Angular gyrus- Damage=writing, reading and naming impairment; transcortical sensory aphasia

Motherese

Also child-directed speech (CDS) Has characteristics that help babies attend and respond to speech Higher pitch and pitch fluctuations Simpler utterances, long pauses, shorter utterances

*Acoustic reflex response test*

Also use impedance meter Administer loud low-freq sound to ear Normal tensor tympani & stapedius acoustic (muscles of the middle ear) reflex temporarily stiffens ossicles, protection from loud noise *85dB HTL* AR's measured: absent=conductive HL; reduced=SNHL Used to *substantiate Tympanometry* findings of high impedance, to determine if middle ear or inner ear dysfunction

Fetal hydantoin syndrome

Also: dilantin embryopathy Maternal use of anti-seizure drug phenytoin Growth deficiencies, underdeveloped fingertoenails, mild dev delays, some cleft palate, small head, finger toe malformations

External thyroarytenoids

Also: muscularis Also shortens VF and lowers pitch X RLN

Miller syndrome

Also: postaxial acrofacial dysostosis *Cranial* malformations (cheekbones, small jaw) *Limb* abnormalities

Statistical regression

Also: stat regression to the mean Factor of internal validity If subjects improve from tx just because they started when symptoms are at extreme, this could be the outcome rather than that tx more effective than other tx Ex: football fans join a study at peak of their hoarseness; of course the 'tx' will help hoarseness

Internal thyroarytenoids

Also: vocalis Vibrates and makes sound Shortens vocal folds and lowers pitch X RLN Below deep layer of lamina propria

Vowels

Always voiced May stand alone Velum always elevated Airflow continuous May be described by: distinctive features, tongue and lip position, tension vs. laxness

50% of irreversible dementia is due to.....

Alzheimer's diseases

Tidal volume

Amount of air inhaled and exhaled during normal breathing

Two factors associated with more rapid, rich language development

Amount of talking (greater amounts) Caregiver responses (immediate and positive)

ALS

Amyotrophic Lateral Sclerosis (Lou Gehrig's) Progressive, fatal UMN and LMN degeneration Breathy, low pitch, monotone Poor resp control Poor response to meds except riluzole which slows muscle deterioration in some Dx: acoustic analysis of voice pitch/amplitude - reduced range occurs before other symptoms Tx: AAC for later stage

Executive function location

Anterior cingulate Dorsolateral pre-frontal corteces

*Cephalometric analysis*

Analyzing size and range of motion of soft palate CAVS (Ceph Ax of VP Structures) is software Gives info on depth of nasopharynx and length of soft palate *60-80; higher=velum to short, pharynx too deep, hypernasality*

Hyperadduction of VFs

Another name for spastic spasmodic dysphonia

Deglutition

Another name for swallowing Moving food from mouth to stomach

Palatoglossus location and function

Anterior faucial pillar Between palatine aponeurosis (section of soft palate) and tongue Elevate tongue, Lower velum (X XI)

Muscles that lower mandible

Ant belly of *digastric* (V), Posterior belly of *digastric* (VII), Genio*hyoid* (XII, C1), Mylo*hyoid* (V)

Oral phase disorders

Anterior (instead of posterior) tongue movement Food residue (anterior and lateral sulcus, FOM)- indicates incomplete swallow Premature swallow Piecemeal swallow

Sheehan

Approach-avoidance: Stuttering person's hesitations and repetitions *indicate a conflict between desires* to approach speaking situations and equally strong desire to avoid them

Diaphragmatic-abdominal Breathing

Appropriate Little-no chest/shoulder movement

Contrastive analysis

Appropriate for CLD client To establish if speech pattern is cultural or disorder

Conceptual scoring

Appropriate for bilingual children Get the big picture of their language status by informal testing in both languages

Study of syntax

Arrangement of words to form meaningful sentences Word order and overall sentence structure Rules that specify how words can be combined

Major categories of articulation errors

Articulation errors are due to motoric inability Substitution (t for th) Deletion (/bo/ for /bot/) Labializatin (excessive lip rounding) Nasalizatin (oral are nasal, esp g) Pharyngeal fricative (h in pharynx) Devoicing Frontal/Lateral lisp (sibilants) Stridency deletion (sometimes phon process) Unaspirated Position errors of specific phonemes Pre-inter-post vocalic errors (consonant errors next to V's)

Muscles that move the epiglottis

Aryepiglottic muscles: pull epiglottis back and down to arytenoids (which rock forward and complete closure of vestibule) Thyroepiglottic muscles: pulls epiglottis back up, opening posterior entry to larynx

Semantic ax

Ask parent to describe types and number of words used Ask child to describe things, tell stories with pictures, retell story

Outline of Ax

Assess: Repetition Naming Sentence and discourse production Speech fluency Functional communication skills Comprehension of spoken Comp of single words Comp of sentences, paragraphs, discourse Reading Writing Gestures Automatics/singing Bilingual: Hx of both lang and use, functional comm, differential impairment between langs, interpreter, avoid bilingual tests with no standardization

Ventricular dysphonia

Associated w severe muscle tension ● Compensatory: in reaction to a true vocal fold disease or disorder (ex: VF paralysis, surgery to VF) ● Noncompensatory (VFs normal): habitual: often due to excessive vocal fold use ● Noncompensatory: psycho-emotional: provoked by psychological or emotional stress

Circle of Willis

At base of brain Formed by two carotids and two vertebral arteries Gives rise to: three pairs cerebral arteries Common blood supply to all cerebral arteties so blocks below circle can be circumnavigated

DSM-V on dx criteria for phonological disorder

At least 3 diagnostic criteria

Phonological awareness treatment

Attention to internal structure of words Metalinguistic awareness- ability to manipulate and think about structure of language

ABR

Auditory Brainstem Response Records electrical activity in CN VIII, brainstem, and cortical brain areas Useful for infant/newborn screening, if fail, return in 6 mo If ABR delay, possible tumor Screen at 40dB HL

VIII - name, S, M

Auditory(Acoustic) / Vestibulocochlear nerve S: (auditory) hearing, inner hair cells, and (vestibular) balance M: outer hair cells Damage: Hearing loss, problems with balance, or both

Medula (Brainstem)

Automatic bodily functions VIII-XII (Very important for speech production)

Crouzon

Autosomal dominant Craniosynostosis (misshapen head due to defective bone growth in skull bone joints) Wide apart eyes, parrot nose, tall forehead Hypoplasia, class III *malocclusion*

Pierre-Robin syndrome

Autosomal recessive may be part of Stickler syndrome *Mandibular hypoplasia*, soft palate cleft, deformed pinna, middle ear problems (cond HL) Glossoptosis - congential tongue too far back, blocking airway; nasogastric feeding

Hurler's syndrome

Autosomal recessive deficiency of X-L Deficiency of *idurondiase* enzyme Dwarfism, hunchback, ID, short bones, low nasal bridge, SNHL, hoarseness due to deposits in larynx Protuberant abdomen, thick lips, large tongue

Marfan syndrome

Autosomal, dominant inheritance Long *thin limbs* Connective tissue affected High arched palates and occasional cleft palate but little orofacial malformations

Ax of cleft

Ax velopharyngeal function: -Nasopharyngoscopy- posterior and lateral pharyngeal wall, nasal aspect of velum and adenoid pad -Oral manometer: ratio of 1 normal less than one=VPI

Milieu teaching technique

Method teaches functional communication skills through typical everyday verbal interactions that arise naturally Types: Incidental, Mand-model, Time delay

Standardized tests for Aphasia

BDAE WAB MTDDA Neurosensory Center for Comprehensive Exam for Aphasia Multilingual Aphasia Examination Porch Index Comm Ability( requires intensive training, has limited use) Aphasia Dx Profiles

Oscillation

Back and forth movement of air molecules due to vibrating object

Disorders of resonance Cul-de-sac resonance

Backward retraction of tongue Distorted voice due to tongue blocking part of sound Deaf and neurological disorders often have difficulty with this

Subcortical aphasia general

Basal ganglia and surrounding structures, thalamus + fluent + aud comp + repeat - naming (paraphasias) May have: hemiplegia, initial mutism, R visual field probs

Basilar membrane frequency responses

Base - higher frequencies (doormat- why higher frequencies are the first to go) Apex - lower frequencies (longer piano strings are the lower pitches on a piano, same here because tip is further or longer distance from base)

Base (root or free) vs. Bound (or grammatical) morphemes

Base: cannot be broken down (e.g. ocean, book, establish) Bound: do not convey meaning by themselves; must be joined with bound (e.g. -ing, -s, -ed)

Metaphon theory of phonology

Based on metalinguist awareness Helps child improve acquisition of phonological rules

BICS

Basic Interpersonal Communication Skills -2 years to develope to native-like skill by child learning English as second language

Oral phase

Begins with anterior-to-posterior tongue action- moves bolus posteriorly Phase ends as bolus passes through anterior faucial arches when swallowing reflex initiates

Dore functions

Between 12-24 months Children's intent when using language: Practice (language) Protest (no) Greet (hi) Call (mommy!) Request an action (juice?) Request an answer (cow?) Label (eyes) Repeat/imitate Answer adult

Service delivery for CLD who qualify

Bilingual special education classroom Monolingual SE classroom with bilingual support Pull-out in primary lang Pull-out in English with primary lang support Consultive with ESL or bilingual staff Placement in regular bilingual ed or ESL with support from SE

Distincive Features use

Binary system Categories: voice, consonantal, vocalic, anteior, coronal, high, low, back, continuant, nasal, strident Approach tries to find child's pattern, train sounds in that pattern for generalization Uses minmal pairs

Purpose larynx

Biological: breathing, coughing, sneezing Phonatory function not possible when these three are being utilized

Sensorimotor substage 1

Birth - 2 months -*Reflexive* vocal behavior -Reflexive sensorimotor behavior

Surgical modifications and implantations

Blom-singer thracheoesophageal puncture (TEP): Shunt between trachea and esophagus Self insert or dwelling To speak pt occludes stoma Air passes from trachea to esophagus Esophagus vibrates

BAHA

Bone anchored hearing aid Sound box implanted on side of skull Sounds hit box, vibrations stimulate cochlea, sent to auditory nerve Best for monaural hearing loss

Arthrogryposis

Born with joint contractures, don't move as normal and may be stuck in one position

Thoracic breathing

Both clavicular and diaphragmatic-abdominal breathing No abdominal or upper thoracic expansion

Bilateral VF paralysis

Both folds may be stuck in halfway open closed position If so, Tracheotomy required May be wide-open glottis, if so, aphonia If paralyzed in abducted position, aspiration If paralyzed in adducted position, struggle for breath, but voice not dysphnonic

Horse

Breathy and harsh Irregular vocal fold vibrations

Indirect laryngoscopy

Bright light source Small, round, 21-25mm mirror angled on long, slender handle to lift velum and press gently on pt posterior pharyngeal wall View larynx during quiet respiration and during 'eeee' phonation

Non-fluent aphasias

Broca's Transcortical Motor Aphasia Mixed transcortical Aphasia Global Aphasia

Apraxia of speech

Broca's + suppl motor area Impaired capacity to plan or program sensorimotor Accompanies Broca's (freq) and (less) unilateral UMN dysarthria Diff prosody, groping, fluency

Brodmann's area 44

Broca's area

Wernicke's

Brodmanns 22 Posterior sup temp gyrus Tempo-parietal junction + fluent - aud comp - repeat

Most muscles of the face are innervated by...

Buccal or mandibular marginal branches of VII (facial)

Muscle that makes a smile

Buccinator (VII) Called lip eversion

Muscles that flatten cheeks

Buccinator, Risorius (VII)

Phonetic derivation method

Builds on oral skills client already has Ex. client can pop lips, so then train this manner and place for bilabials

CALMS Rating Scale

C - *Cognitive* (awareness, perceptions) A - *Affect* (attitudes and feelings) L - *Linguistic* (overall lg abiltiy and complexity) M - *Motor* (#reps, freq, SSI) S - *Social* (avoiding, peer relationship, situations)

Analog hearing aid components

Microphone, Amplifier, Receiver, Power source, volume control Transducers contain microphone and receiver Least effective aid, least expensive

Tx adductor spasmodic dysphonia

CO2 laser surgery (paralyzed fold is thinned) RLN resection (paralyzes VF that side) Botox injections (creates flaccid paralysis, ev 3-6 mos) AAC (amplify voice) Voice therapy (inhale phonate, incre pitch, relax, head turn, counseling, yawn-sigh, soft onset using /h/)

CHILD LANGUAGE DISORDERS SECTION (PG. 133-150)

CHILD LANGUAGE DISORDERS SECTION *confirmed*

CHILD SSD TX and AX SECTION (PG. 204-220)

CHILD SSD TX and AX SECTION *confirmed*

CLEFT

CLEFT

Bell's palsy

CN VII LMN lesion - both upper and lower facial weakness on same side of lesion

Auditory nervous system

CN VIII: Balance from Vestibular branch; Hearing from Auditory/Acoustic branch Nerve exits inner ear via Internal Auditory Meatus to brainstem, then most fibers decussate

Unilateral UMN

CN's UMNs unilateral Lower face weakness, palatal weakenss, tongue weakness, incoordination, articulation, hemiplegia

Reticular activating system

CNS's primary mechanism of attention alertness and consciousness Also maintains states of consciousness (sleep, wake, drowsiness, alertness, excitement)

COUNSELING

COUNSELING

Syntactic ax

Calculate MLU Evaluate verb, noun, prepositional, phrases Evaluate sentence type

Paradoxical vocal fold motion

Called PVFM, also: laryngeal dyskinesia or episodic paroxysmal laryngospasm (EPL) inappropriate VF adduct during inhalation, exhalation or both Tx: combination medical behavior psychosocial Some endoscopy plus direct feedback to relax larynx

Surface dyslexia

Can be associated w aphasia Unable to retrieve whole word representations Rely on letter by letter pronunciation rules Tx: work on irregularly spelled words

Cluttering

Can coexist with stuttering Rapid, unclear, highly disorganized articulation, omitting syllables, compressed syllables, spoonerisms Can be jerky, monotonous Lack of anxiety about disorder Commonly develops in childhood Tx: reduce rate of speech, incr awareness via audio/video

Common medical problems of Hispanics

Cardiovascular disease Strokes and diabetes

Voice Ax

Case Hx Team oriented Instrumental evaluation Perceptual evaluation (pitch, loudness, resonance[hyper/hyponasal], respiration, phonation[max phonation time; s/z ratio])

Ax of SSD

Case hx Screening Oral peripheral examination Hearing screening Lang assessment if lang probs suspected Further general assessment: -Performance in single-word positions and conversation -Presence of phonological processes -Performance based on developmental norms -Stimulability -Identify potential treatment Related ax objectives: -Audiological ax -Physical/neurological disabilities -Dental abnormalities -Influences of other lang or dialect -Concomitant lang probs -Intellectual and behavioral ax

Oral Manometer

Catheter passed through nose Pt sucks/blows into mouthpiece Ratio of inhale/exhale pressure readings Less than .89 indicates a problem

Landau-Kleffner syndrome

Cause unknown Form of *aphasia* in age 3-7, loss of ability to comprehend lg and speak, gradual or sudden Some permanent severe some regain language over months/years Some relapses Abnormal brain waves, 80% have epilepsy Some hyperactivity, aggressiveness, depressed

Assimilation

Causes a sound to change to a different sound

Contact ulcers

Causes: Chronic throat clearing, forceful speech, excessive talking, (slamming together arytenoids), hard glottal attack Intubation Gastric reflux

TBI in children

Causes: MVA, sports, falls, abuse, assault, domestic violence, gunshot woulds Multidisciplinary approach always needed Imm effects: coma, amnesia, aggressions etc, motor issue Cog/Lg: aud comp sentences, word finding, syntax, limited MLU, reading/writing, pragmatics, attn, men, awareness TBI difficulties, slow info processing, poor reasoning/org, frustration Ax: in natural settings; std tests not sensitive to their issues

Interval-level rating

Celsius/Fahrenheit is this equal intervals between numbers

Displacement

Change in position Air molecules can be displaced

Pull out

Changing stuttering mid course Slowing down and using soft articulatory contacts

Preparatory set

Changing the manner of stuttering Making it less abnormal

Demands and capacities model

Child is unable to cope with expectations of fluent speech production and may begin to stutter

Phonological process approach

Child's errors are described as phonological processes not a s discrete sounds Hodson and Paden approach uses this

Recasting technique

Child's limited sentence repeated in modified form with changed modality or voice (baby is hunger -> is she hungry? / dog chasing cat -> cat being chased by dog)

Nativist theory lang acquistion

Chomsky -Also called Innateness; also called Transformational Generative Theory of Grammar; Chomsky called it Minimalist Program -Child born with LAD (lang acquisition device)-Helps child learn language over time -Language is NOT learned through environment, teaching, or reinforcement -'Competence (knowledge)' and 'performance' distinctions -'Surface (arrangement of words)' and 'deep (rules)' structure -'Transformations' related surface to deep; involve arranging/rearranging to change sentences -All human languages share common principles (all have nouns, verbs, etc) -Critical time period which requires exposure for lg acq (ends around 12yrs); doesn't believe in reinforcement due to LAD -In therapy focus heavily on *syntax*

Smith-magenis

Chromosomal disorder Normal/broad face appearance Infant feeding probs Low muscle tone Developmental delays Hyperactivity, attn probs

Vocal dysfunction

Chronic hoarseness Diff breathing while voicing Asthma, GERD

Considerations for adult multicultural clients in rehab

Church connections Ideas of independence May have little money/insurance Extended family roles Premorbid education/vocation Beliefs about diesease Ax skills in both lang for bilinguals

Brutten and Shoemaker

Classically conditioned negative emotion: Stuttering limited to *part-word repetitions and prolongations* Due to *classically conditioned negative emotion* *Some are operantly conditioned*

Common medical problems in Asians

Cleft palate Otitis media Smoking Alcoholism and fetal alcohol syndrome

Integrated approach

Client-specific stimulus materials, sample communication in natural settings, eval each skill in depth Targets of ax always functional, meaningful communication social contexts.

Extension technique

Clinician comments on child's utterances, adds new relevant info (play ball -> Yes, you are playing with a big, red ball) Key difference in extension vs expansion: extension adds new info

Self-talk technique

Clinician describes her own activity while playing with child

Expansion technique

Clinician expands child's telegrahic/incomplete utterance to more grammatically complete utterance (doggy bark -> Yes, the dog is barking)

*Thermal stimulation*

Clinician touches pt base of anterior faucal arches with laryngeal mirror dipped in ice water for about 10 sec To increase sensitivity in arches, tongue base and velum *in cases of delayed swallow*

Language

Code or system of symbols used to express concepts Speech is the production of language

Information processing theory of lang acquisition

Cognitive functioning, NOT cog structures are needed for lg Focus on *How language is learned* Posit processing steps (*cognitive* *connectionism*): organization, memory, transfer, attention, discrimination 2 main areas of deficit in disorders: phonological *processing* and temporal auditory *processing* Study in TAP: capacity and rate Tx: Auditory discrimination, aud attn, aud mem, aud rate, aud sequencing Research: working mem and processing speed goals are helpful and can benefit cog processing skills

Piaget stages

Cognitive theorist proposed 4 stages overlapping development: -Sensorimotor (infant) -Preoperational (toddler, early childhood) -Concrete operations (elementary) -Formal operations (adolescent)

CALP

Cognitive-Academic Language Proficiency -About 5-7 years to develop to level of native English speakers

Speech sound (artic) ax

Collect 50-100 utterances Spontaneous conversation and evoked samples (imitation, naming, sentence completion) Select errors, ax stimulability Above is informal, but formal tests available

Cleft of prepalate

Combination of previous types with or without prelate protrusion or rotation

Juncture

Combination of suprasegmentals such as intonation and pausing, which mark special distinctions or grammatical divisions in speech Ex: I scream, ice cream

Fluent aphasias key cortex area

Common integrative area (Brodmanns' 5,7,39,40)

Mixed Flaccid Spastic

Common with ALS

Mixed Ataxic Spastic

Common with MS

Tx aud comp

Comp of single words: nouns and verbs Comp of spoken sentences: understanding questions, following directions, sentence verification Discourse comp: narratives and questions

Cleft lip

Complete or incomplete Unilateral or bilateral

Difference Developmental and Complexity approaches

Complexity will usually take longer to achieve increased intelligibility Consider: child's ability to handle frustration, and time frame alloted before improvement desired by parents

Autonomic nervous system

Components: Sympathetic nervous system Parasympathetic nervous system

Langauge prob TBI

Comprehension, esp sentences Word-retrieval, reduced fluency

Tomography

Computerized radiographic method of taking pictures of different planes of body structures. Used to scan brain structures.

Communicative Consistency

Concept loks at how functional words are in child's communication environment May focus on: stop, go, yes, give me, more, etc

Phonetic

Concrete productions [ ]

Otosclerosis

Conductive HL May be inherited, more common in women Spongy growth on stapes footplate reducing ossicle movement Will have carhart notch on audiogram

Laryngomalacia

Congenital Soft, floppy laryngeal cartilages, esp epiglottis Sounds like stridor Usually resolves by age 2-3 w/o TX

Arcuate fascilicus

Connects Broca's to Wernicke's Part of speech-production pathway

Brainstem

Connects spinal cord with brain via diencephalon Internally consists of longitudinal fiber tracts, cranial nerve nuclei, and the reticular formation Reticular activating system integrates in and out neural activity in brainstem and upper spinal cord Outwardly key structures include the midbrain, pons and medulla

Alternative form validity

Consistency of measures when two forms of the same test are administered

Test-retest reliability

Consistency when same test is administered to same person twice

In general, stuttering more likely to occur on

Consonants vs vowels First sound/syllable of word First word/phrase of sentence First word grammatical clause Longer words Less freq used words Content words vs functor words (except early preschoolers more on functors) Preschoolers have more whole word repetitions

Distinctive features analysis

Contains linguistic descriptions of the world's speech sounds Distinctive feature: unique characteristic that distinguishes one phoneme from another REVIEW ON PG. 73

Medulla oblongata

Continuation of the spinal cord within the skull forming the lowest part of the brainstem, containing control centers for the heart and lungs.

Reinforcement schedules

Continuous - every performance Intermittant - after ratios/intervals Fixed - set time or responses Variable - unpredictable time or responses Interval - based on time Ratio - based on number responses Compound - combination 2 or more using same reinforcer Resistance to extinction: variable ratio schedule

Corticobulbar tract

Control all voluntary muscles of speech (except respiratory) Decussate (cross) at brainstem where CN's III-XII transition from UMN to LMN With the exception of lower muscles of facial expression, all functions of the corticobulbar tract involve inputs from both sides of the brain.

Anomic aphasia

Controversial Lesions in different regions: Angular gyrus, second temporal gyrus, juncture of temporoparietal lobes + fluent (except for pauses) + aud comp/ read comp + repeat (debilitating word finding, no impairment of pointing to named objects, use vague words (empty speech), verbal paraphasia (word substitution), circumlocution, normal oral reading/reading comprehension and writing)

Moebius syndrome

Cranial nerve V and XII sometimes VII) problems Tongue bilabial paresis, weakness Mask-like face, weakness or paralysis Many small chin, possible cleft Some: cond HL, lang delay due to hospitalization, articulation disorders

Residue in pyriforms - cause

Cricopharyngeal dysfunction

Alternative assessment approaches for CLD

Criterion-referenced approaches Authentic and contrastive analysis Dynamic assessment Portfolio assessment Comprehensive and Integrated assessment Overall: sample more naturalistic comm skills for more reliable and valid info than from standardized tests

What are CPT codes?

Current Procedural Terminology Used with ICD-10 for billing and documentation Refer to procedures and tx's Has time and service codes

HL and children's hearing/language abilities

Cutoffs: 15dB - normal hearing 40dB - diff hearing distant speech 55dB - sp and lg acquisition delay 70dB - only amplified speech understood 90dB - deaf

Frequency

Cycle per second Hz Period= amount fo time needed for a cycle to be completed

Shimmer

Cycle-to-cycle variation in amplitude More than 1dB is considered problem

Jitter

Cycle-to-cycle variation in frequency More than 1% considered problem

FOCUSED tx

For Dementia F - Functional, face to face O - Orient to topic (nouns vs prns) C - Continuity of topic, concrete topics U - Unstick communication blocks S - Structure for responses (yes/no/choice) E - Exchange (encourage interaction) D - Direct, short, simple sentences

Anterior cingulate cortex

Frontal part of cingulate cortex Resembles 'collar' around front of corpus callossum Brodmanns 24, 32, 33 Autonomic functions, blood pressure, heart rate Higher-level function role: reward anticipation, decision making, impulse control, emotion

Conductive hearing loss

Efficiency of sound conduction in outer/middle ear diminished Inner ear, acoustic nerve and auditory centers are working Bone conduction= normal Causes: abnormal external auditory canal, tympanic membrane, or ossicular chain of ME Can often hear themselves well (speak soft)

Strain-strangle

Effortful Initiation and sustaining are difficult Fatigue

Dementia vs aphasia

D: -behavior, pragmatics, expressions, nonverbal and verbal intelligence tests + slow onset, confused, disoriented A: -word retrieval, naming, verbal intelligence tests + problem solving, nonverbal intelligence, sudden onset, aware

Language probs ADHD

DSM-V: 2 areas - attn; hyperactivity, impulsivity 6 months min, onset before 7yrs Behavior issue: constant fidget, can't stay seated, highly distracted other stimuli, diff sustained attn, diff turns in play, freq loss necessary items for school, freq participation dangerous activities Biggest difficulty in many social skills areas/pragmatics ADHD is most common comorbidity of expressive lang disorders Ax: must include pragmatics or won't qualify Tx: aud processing, pragmatics, exp lg organization

DYSPHAGIA SECTION (PG. 370-377)

DYSPHAGIA SECTION- *confirmed*

Sensorineural hearing loss

Damage to har cells of cochlea, or acoustic nerve Permanent loss Bone and air conduction are impaired Difficulty hearing themselves (speak loud)

Retrochochlear disorder

Damage to nerve fibers from internal auditory meatus to cortex (at cerebelopontine angle) Usually tumors/neuromas (acoustic neuromas) Also compromises V VII so may be facial sense/movement impairment HF HL, tinnitus, dizziness May be caused by von Recklinghausen disease- small tumors along cranial nerve VIII

Differential reinforcement of low rates of responding (DRL)

Decreasing undesirable behaviors by gradually reinforcing progressively lower frequencies Ex: ask fewer questions/ask many

Reaction formation

Defense mechanism of clients who experience thoughts that are shocking and unacceptable to them, so they react with complete opposite emotions.

Projection

Defense mechanism where the client attributes their own emotions, thoughts, or actions to someone else.

Displacement

Defense mechanism where the client takes his/her feelings of anger about a situation and transfers them to a safe object or person. Ex: Family lashes out in anger to SLP, says SLP is wrong, is pessimistic and negative about client and her abilities

Suppression

Defense mechanism where the clients keep their feelings and thoughts highly controlled but are consciously aware of those feelings.

Repression

Defense mechanism where the clients keep their thoughts and feelings under strict control and out of view of others; clients may not be aware of these thoughts and feelings.

Rationalization

Defense mechanism which is a form of resistance, client provides a logical but untrue explanation of why something has occurred. EX: "No one will talk to me because I stutter"

Three categories of dysarthria (etiologies)

Degenerative neuro disease: PD, ALS, MG, MS, Huntington's, dystonia, Wilsons) Non-progressive neuro conditions: stroke, infections, TBI, surgical trauma Congenital conditions: CP, Moebious, encephalitic, toxins alcohol/drugs

Manner

Degree or type of constriction in vocal tract E.g. Nasals, stops, fricatives, affricates, liquids, glids, laterals

DAF

Delayed Auditory Feedback Stutterers: results in slowed speech; corrects or bypasses abnormal speech-auditory feedback loop Clutterers: Syllable awareness and incr fluency

Angelman syndrome

Deletion maternal chromosome 15 Duplication father's *15* Onset 3-7 years Normal facial appearance Happy demeanor, episodes unprovoked laughter Developmental/learning delays, ataxia, nonverbal, receptive better than expressive

*Wernicke Korsakoff syndrome*

Dementia caused by *prolonged alcohol abuse*

DAT

Dementia of the Alzheimer Type Cortical dementia Intellectual in early stage, then lang deterioration precedes motor deficits

Excessive tonsil and adenoid tissue

Denasal voice quality Like when person has a cold

Nerve cells endings

Dendrites - receive signals Axons - send signal on

Linear theory of phonological development

Describe patterns occurring naturally in lang Creates rules to account for these systems, apply universally Identify universal principles applicable various phonological systems All speech segments are arranged in a sequential order No one specific sound has control over others Rules apply to linear strings of segments Asssumes linear strings and bundled sounds with own independent set of features

Auditory training

Desktop auditory trainers FM auditory trainers Reduce signal-to-noise ratio- Difference in dB between the stimulus and the competing background noise

Pure tone audiometry

Determine threshold of hearing at selected frequencies *Threshold*= intensity level where a tone is faintly heard at lest 50% of the time Test 1k, 2k, 4k, 8k, 250, 500 Hz Bone-conduction: bone vibrator, sensorineural portion of mechanism, masking used Air-conduction: masking used when one ear is substantially better than the other

Typical development 7-9 months

Dev stage: recognizes names common objects, knows no, plays peek-a-boo, variegated babbling, combines sounds, plays with intonation, begins object permance (uncovers hidden toy)

Typical development: 4-6 months

Dev stage: responds with arm raising for picking up, moves/looks to named fam members, exploring vocal mechanism with raspberries/growls/etc, begins adult vowels, marginal babbling, responds to name, vocalizes pleasure, plays with pitch/volume

Typical development: 0-3 months

Dev stage: startle response, visually tracks, smiles reflexively, attends voice, cries for help, quiets when picked up, produces vowels, coos when person talks

Typical development 10-12 months

Dev stage: understands 10+ wds, first true word, gives on requeset, obeys some commands, object permanance, turns head instantly to own name, gestures wants, jabbers loudly, plays with all consonants and vowel sounds

Children with dysarthria, articulation problems

Devoicing of voiced or other voicing errors Bilabial/velar easier than alveolar, than affricates, fricatives, liquids Stops, glides, nasals easier Tx: repetitive and structured, incr muscle tone/strength, ROM, treat other (respiration) affecting intelligibility, if needed-compensatory strategies/AAC

Muscles that assist in inhalation of lungs

Diaphragm (enlarges dimension of thoracic cavity) Following elevate ribcage: *Serratus* posterior superior, levator *costarum* brevis, levator *costarum* longis, *external* *intercostals* (Parasympathetic nerve fibers)

Pharyngeal phase disorders

Difficulties *propelling* *bolus* through pharyngeal into P-E segment; delayed or absent swallow reflex; nasal and airway penetration Food coating pharyngeal walls- *residue* *Inadequate* *closure* of the airway- aspiration before swallow Reduced *base* of *tongue* movement

Description of difficulties in preschool and elementary aged children

Difficulty in comprehending spoken lang Slow or delayed lang onset Limited lang output (exp. lang) Problematic syntactic skills (Short sentences or words instead of sentences) Problematic pragmatic skills (Diff with conversation maintenance, turn taking, repairing conversation, eye contact) Problematic learning of grammatical morphemes (comparatives and superlatives, bound morphemes, overgeneralization)

Dyslexia

Difficulty learning to read

Reinke's edema

Diffuse swelling of lamina propria, degeneration of VF, Causes: smoking, chronic vocal hyperfunction, LPR, exposure to inflammatory stimuli, Hoarseness, lower pitch Abnormal healing, increased mass of vocal folds

Muscles that elevate the larynx (Suprahyoid muscles)

Digastric (V, VII), geniohyoid (XII, C1) mylohyoid (V), stylohyoid (VII) Clue: Similar to those that depress mandible: MS. DG & HG Also: hyoglossus (XII), genioglossus (XII)

Basal Ganglia function

Direct input from frontal lobe, facilitates motor movements, inhibits unneeded movements Spatial-temporal aspects of speech Damage: unusual body postures, dysarthria, change in body tone, involuntary uncontrolled movments interfere with voluntary speech, walk or other movements (dyskinesias)

Direct vs indirect speech acts

Direct- Bring me the ball Indirect- Will you bring me the ball? Wouldn't it be nice if I had the ball?

Psychological Tx

Discuss psychological problems with stuttering Discuss feelings, emotions, attitudes Resolve psychological conflicts Create realistic approach No strong evidence of success when used alone- used with other methods

Intellectual disability (ID)

Disoder with onset during dev. period includes intellectual and adaptive functions, deficits in conceptual, social and practical domains Various inherited/environmental genetic etiologies (Down's, FAS, toxins pre postnatal, rubella, TBI, low birth weight, cranial abnormalities) All language domains; but delayed rather than deviant Some however, may have echolalia, not typical with delay of normal sequence of lang development Originates before age 18; based on IQ

People with hearing impairment manifest the following *speech* problems:

Distortion of sounds (stops and fricatives) Omission of initial and final consonant Consonant cluster reduction Substitution of voiced consonants for voiceless Omission of /s/ in all positions Substitution of nasal consonants for oral Increased vowel duration Imprecise vowels Epenthesis (adding schwa) to consonant blends

Aperiodic waves

Do not repeat themselves at regular intervals Random and difficult to predict

Indirect treatment of swallowing disorders

Does not involve food Oral-motor exercises- Increase tongue ROM, buccal tension, range of lateral movements of the jaw and of tongue movement Stimulate swallow reflex- Icing anterior faucial arch, asking patient to swallow after stimulation without food, practicing liquid swallow after stimulation, increasing consistency of food after stimulation

Prognosis

Don't promise specific outcomes Make reasonable statement possible outcomes under specified conditions

Diplophonia

Double voice Two distinct pitches Vocal folds vibrate at diff frequencies Different mass/tension (e.g polyp)

Psychoneurosis theory

Due to underlying psychopathology and psychological conflicts Freudians proposed this theory

Neurogenic stuttering characteristics

Dysfluencies on function words Lack of adaption effect Minimal/no effect of masking noise

Electroencephalography

EEG Electrical impulses of brain through surface electrodes

Electroglottography

EGG, Noninvasive Indirect measure vf closure pattern Surface electrodes on sides thyroid High-freq current passed between Pt asked to phonate Can detect breathy and abrupt glottal onset Recommended as cross-validation tool with other tools for vf function

Electromyography

EMG Invasive Directly measures laryngeal muscle patterns Needle electrodes inserted to peripheral laryngeal muscles Looks for reduced/increased muscle speed activation, bursts of activity, onset/termination activity Useful to determine pathology and to verify excess muscle activity prior to BOTOX injection

ETHICS AND LEGISLATION SECTION (PG. 604-608)

ETHICS AND LEGISLATION SECTION- *confirmed*

ETIOLOGIES & SYNDROMES SECTION (PG. 574-581)

ETIOLOGIES & SYNDROMES SECTION- *confirmed*

Theories of language development

Each describes a process to reach a basic research goal: Socialization Biological Linguistic Social Domain general cognitive Dynamical systems (self organizing processes discussed, which describe dev changes and variabiltiy in child's language performance)

Multidisciplinary

Each member does own eval Writes separate reports Little interaction with team

Central auditory processing disorder

Effectiveness of CNS to use auditory info (central auditory processing) HL due to disrupted sound from brainstem to cerebrum Person processes info incorrectly or cortex may receive incorrect information May have no sig cond HL Routine pure-tone and SRT don't catch CAPD Characteristics: poor auditory discrimination, auditory recognition, auditory sequencing skills, auditory closure, listening with background noise, auditory attention, auditory memory, auditory location, understanding rapid speech, following melody, academic problems, vocabulary and pragmatic skills

High-tech

Electronic instruments

Serratus anterior

Elevates arm (boxer's punch muscle) Elevates ribs 1-9

Digastric

Elevates hyoid or if hyoid is fixed, lowers mandible - VII

Sternocleidomastoid

Elevates sternum, indirectly elevates rib cage

Trapezius

Elongates neck, indirectly influence respiration

Closed syllables

End in consonants

Open syllables

End in vowels

Vocal fold layers

Epithelium Lamina propia Vocalis muscle (TA muscle)

Components of the cover

Epithelium Superficial lamina propria (Reinke's space) Much of the intermediate lamina propria

Distinctive features approach

Establish missing distinctive features Discovers child's underlying patterns Uses minimal pairs in tx

Audibility index

Estimated % of acoustic energy from speech audible to an individual Also used in hearing aids: what % speech sounds are delivered to client

Bones of nasal septum

Ethmoid Vomer bone Quadrangular Cartilage of Septum

Functional Ax Aphasia

Eval daily communication everyday settings Less biased than standzd tests FCP - Func Comm Profile CADL-2 - CommAbil in DLiving BOSS- Burdn of Stroke Scale CEI - Comm Effectiveness Index FACS - Func Ax Comm Skills4Adults Amsterdam-Nijmergen Everyday Language Test

SPECT

Evaluates the amount of blood flowing through a structure. Pt inhales xenon 133 (gas)

Basic Behavioral technique

Evidence based for following behavior techniques: Instructions Modeling Prompting Shaping (break down complex response) Manual guidance (offer physical assistance for response) Fading Immediate response continguent feedback (positive/corrective)

Typical development 3-4 years

Exp 900-1000 words Rec 4200 words by 42 months; 5600 by 48 months Clause-connecting (and) Complex verbs Tag questions (don't you?) Passive voice Opposites Answers 'what if' questions Modify speech to age of listener Can maintain conversation MLU: 3-5

Cause of aspiration in pharyngeal phase

Failure of airway protection mechanisms: -reduced hyolaryngeal extension -impaired epiglottic tilt -incomplete closure laryngeal vestibule or VF

Ventricular vocal folds

False vocal folds Superior to true vfs Vibrate at low fundamental freq- do not normally vibrate during typical phonation Compress in coughing or lifting heavy items

Pre-test Post-test control group design

Experimental group and control group

4-year-old syntax skills

Expr 1200-2000 Rec 5600 Coordination, subordination Complex verb phrases begin Modal verbs begin Tag questions begin Embedding begins Passive voice begins Mostly uses complete sentences, nouns, prns, verbs Inserts 'do' for transformations (does the kitty run around) 7% sentences complex or compound Only about 8% of sentences are incomplete MLU: 4.5-7

Purpose of AAC

Express wants and needs Transfer info Promote social closeness Participate in social etiquette Communicate with oneself

Babinski sign

Extensor plantar response

Aural atresia

External auditory canal closed Birth defect Cond HL

Alaryngeal speech 3 types

External devices Esophageal Speech Surgical modifications or implanted devices

Cochlear implant components

External: Microphone, Processor, Transmitter Internal: Implanted receiver http://nmff.org/documents/OtolaryngologyHeadandNeckSurgery/Otolaryngology.CochlearImplant.FAQ.pdf

To decrease a behavior, reinforcements that may be used are:

Extinction Reinforcing incompatible behavior Relaxation Self-monitoring Shaping

Down's syndrome

Extra chromosome *21* Macroglossia

Formants

F2 - tongue retraction/advancement (forward=high; back=low) F1 - tongue height (high=low; low=high) F0 - larynx Tx: If F2 is low, push tongue forward

FLUENCY SECTION (PG. 231-270)

FLUENCY SECTION- *confirmed*

FOLLOWING ARE SPECIFIC TX TECHNIQUES - LANG/BEHAVIOR (PG. 164-171)

FOLLOWING ARE SPECIFIC TX TECHNIQUES - LANG/BEHAVIOR- *confirmed*

FORMAL TESTS SECTION

FORMAL TESTS SECTION

VII - name, S, M

Facial nerve S: *ant 2/3 tongue taste* M: *Facial* *expression,* *speech;* Including buccinator, zygomatic, orbicularis iris, obicularis oculists, platysma, stapedius, stylohyoid, frontally, procures, nasalis, depressor labii inferiors, depressor angel iris, auricular muscles, various labial bumbles, posterior belly of the digastric Damage: Mask-like appearance

Multiple Treatment Interference

Factor of external validity Positive or negative effect of one treatment over another

Reactive or interactive effects of pretesting

Factor of external validity Pretest may sensitize participants to the treatment E.g. questionnaire might influence behavior

Hawthorne Effect

Factor of external validity When pts modify their performance in response to awareness of being observed

Maturation

Factor of internal validity Biological and other changes that can have an effect on dependent variable

Attrition

Factor of internal validity Losing participants

Instrumentation

Factor of internal validity Problems with devices

Tx of Hyponasality

Feedback with nasometer *Focusing* on tone into facial "mask" *Nasal-glide* stimulation- select words with glides and nasals and practice *Visual* *aids*

FEES

Fiberoptic Endoscopic Evaluation of Swallowing Less expensive than VFSS Superior view (from top) Only SLP performs No radiation Pharyngeal Phase

Cochlea

Filled with endolymph Floor called basilar membrane- contains the organ of Corti- contains hair cells (cilia- each ear has ~15000) Vibrations from stapes go through oval window- through reissner's membrane- to basilar membrane

Phonological processes continuing after age 3

Final consonant devoicing Cluster reduction Stopping Epenthesis Gliding (liquids become glides) Depalatization Vocalization

Cerebellum

Fine motor coordination Received neural impulses from other brain centers and helps coordinate and regulate them; e.g."Modulator" of neural activity Equilibrium, posture, coordinated fine motor movement Damage to Cerebellum= Ataxia

Hearing aids - fitting, types

Fitting: check client motivation Types: in the ear (concha), behind the ear, body aid, in the canal, completely in the canal (next to TM) also some are eyeglass variety (built into eye glass) and disposable

Meniere's disease

Fluctuating SNHL SNHL in low-midrange freq's HL, vertigo, tinnitus

Spasmodic dysphonia

Focal laryngeal dystonia No structural anomolies in larynx, it is neurological Dystonia is: movement disorder causing muscles to contract, spasm involuntarily Usually lesion site in CNS/brainstem 2 types: abductor (reduced loudness, occasionally aphonic) and adductor (more common type, sounds choked or strangled) Sound older, tearful to unfamiliar listeners Tx: botox, RLN resection

Developmental approach

Focus on earlier developing sounds first

Glottal fry

Folds held tight together Free edges bubble sound out Popcorn sound

Oral preparatory phase

Food placed in mouth is masticated Masticated food is prepared for swallow making a bolus

*Metronomic* pacing

For AOS. Uses *tapping per syllable* to help maintain rhythm and *slow pace*

SCERTS model

For autism (Asperger's) SC - Social Communication ER - Emotional Regulation TS - Transactional Support Child learns from and with children who have social and lang models in as inclusive setting as possible TS's could be: visual supports, environmental arrangements, communication style adjustments

*Supraglottic* swallow

For: *Delayed pharyngeal swallow* Reduced or delayed initiation laryngeal closure How: Pt *hold breath while swallow*, *cough*, swallow again

Chin-*tuck* technique

For: *Premature spillage*, *reduced VF closure*, *delayed pharyngeal swallow* How: Chin down to move bolus anterior *Widens valleculae* so spillage hesitates there giving more time for VF closure Helps narrow airway entrance, pushes epiglottis posteriorly

*Effortful* swallow

For: *Reduced BOT retraction and pressure in pharyngeal phase* *Food residue in valleculae* How: *Swallow hard* w tongue pushed up on roof of mouth increases BOT movement to clear bolus from valleculae

*Super-supraglottic* swallow

For: *Reduced laryngeal closure* *Combo* of supraglottic and effortful Closes airway at three points How: Inhale, hold breath, *bear* *down* tightly, hold during swallow, cough to clear

*Masako* maneuver

For: *Reduced pharyngeal constriction* How: *Hold tongue between teeth* during swallow (BOT contacts pharyngeal wall)

*Mendelsohn* maneuver

For: *reduced laryngeal elevation* plus *reduced UES opening* How: Swallow normal, feel larynx lift; swallow, feel and *hold larynx up after it lifts*, finish swallow (longer elevation of larynx normalizes timing of pharyngeal swallow)

*Head tilt* technique

For: One-sided oral or pharyngeal weakness, residue on one (weak) side mouth/pharynx How: *Tilt head to strong side*, bolus will go down where wall most intact

*Shaker* maneuver

For: Reduced UES opening, residue in pyriforms How: *lie on back*, no pillow, lift head to look at toes, shoulders down, hold 30sec Reverses gravity effect so residue stays pharyngeal wall not pyriforms *Strengthens* outer neck and throat muscles Not for hx reflux or arthritis

Valsalva maneuver

For: Reduced laryngeal closure For voice or dysphagia tx Attempt exhale against closed airway, also pinch nose to incr thoracic pressure

Chin-*up* technique (*head back*)

For: Reduced tongue control Oral/lingual deficits Only if pharyngeal swallow is intact *Narrows valleculae* How: *Uses gravity* to clear oral cavity

*Head turn* (rotation) technique

For: Weak one-sided pharyngeal contraction on weak side, also for pocketing, CP dysfnction How: Rotate head *to damaged side* Increases pharyngeal pressure on weak side *Decreases UES resting pressure on strong side* *Increases VF closure*

Pressure

Force per unit area Dynes or newtons

Natural frequency

Frequency with with something normally vibrates

Lobes

Frontal Parietal Temporal Occipital

Attention location

Frontal and parietal lobes

Bicultural

Fully involved in both their own and host cultures

4-year-old language skills

Future tense Define common words Topic maintence several utterance Complete sentences Categorize Present prog -ing

Esophageal phase disorders

Generally caused by *weak* *cricopharyngeus* Difficulty passing food through cricopharyngeus muscle and 7th cervical vertebra Backflow of food from esophagus to pharynx Formation of diverticulum Achalasia- esophageal disorder due to motility impairment or failure of LES to relax

Selective mutism

Generally starts before age 5 Usually dx when school begins May be location specific, like at school not at home Associated with anxiety/normal dev; mutism away from family members

Audiometer

Generates and amplifies pure tones, noise, other stimuli Frequencies from 125-8000Hz Dial attenuates (decreases) intensity of sound

Etiology of celft

Genetic abnomalities- Environmental teratogenic factors- Alcohol, drugs, rubella Mechanical factors-crowding, twinning, tumor, amniotic ruptures

(MOVE) Velocardiofacial syndrome

Genetic autosomal disorder Part chromosome 22 (22q11.2) Cleft of soft palate, funny face Diff feeding as baby (milk comes out nose) Wide nose, small ears, almond eyes, elongated face Sig express lg delays Artic disorders and mental retardation

Williams syndrome

Genetic disorder, *25* missing genes (inc ELN, *ELASTICITY*) "Elfin" charming personalities Low IQ, splinter skills Gregarious, loving CLUE: *Will* Ferrell was in *ELF*

Muscle that forms bulk of tongue

Genioglossus allows it to move freely

Pause-and-talk (timeout) procedure

Give a signal to stop talking Avoid eye contact for 5 seconds Reestablish eye contact Ask client to continue

Differential reinforcement

Give different responses to a stimuli Reinforce the correct response while ignoring the incorrect

Syntactic bootstrapping

Gleitman Idea that children *guess at meaning* of novel verbs based on knowing the syntactic frames for verbs (they know -ing means a verb rather than a noun) (Bootstrapping is a linguistic term for language acquisition)

Corpus Striatum parts

Globus Pallidus, Caudate Nucleus, Putamen Sections of Basal Ganglia - Extrapyramidal - regulate and modify cortically initiated motor movements

IX - name, S, M

Glossopharyngeal nerve S: assists post 1/3 tongue taste, general sensation: tympanic cavity, ear canal, eustachian tube, soft palate, faucial pillars, upper pharynx (gag) M: Stylopharyngeus, pharyngeal constrictors (clear throat) Damage: Difficulty swallowing, unilateral loss of gag reflex, loss of taste and sensation from posterior 1/3 of tongue Parasympathetic: some salivary glands

Glottal replacement

Glottal stop replaces other consonants Ex: tu? for tooth

Physiological voice therapy

Goal: Eval subsystems Develop direct therapy exercises to improve relative balance

Psychogenic voice therapy

Goal: Explore psychodynamics of the voice

Symptomatic voice therapy

Goal: Use facilitating techniques to directly modify vocal components

Fluency shaping method

Goal: establish normal fluency Skills (in this order): -airflow management -gentle/easy onset of phonation -reduced rate of speech through syllable prolongation, no pauses between words Gains: stutter-free speech but not normal sounding speech; relapse common Limitation: Generates slow, deliberate, possible unnatural fluency

Reading change

Grades 4-6: move to reading to learn

Description of language disorders in adolescents Literacy

Grammar Spelling Comprehension Use nontechnical instead of technical Poor letter formation Punctuation Organization

Oral language training Tx focus (HI)

Grammatical morphemes -ed, -s Terms with dual meanings Antonyms Proverbs Abstract terms

*Pic syms*

Graphic *symbols for nouns, verbs, prepositions*

Three passive forces of expiration

Gravity Elastic recoil Torque *Exhalation uses both active (muscles) and these passive forces

Speech reading

HI person using visual cues to 'read' what speaker is saying Unlike cued speech, no signs What used to be called lip reading In English only 30% of sounds are visible on the face Homophenous- look the same (labials)

Central Auditory Disorders

HL due to disrupted signal from brainstem to cerebrum Due to damage or malformation Temporal cortex may receive incorrect info or info may be processed incorrectly

Three types of tx for child speech language disorders (terms used in neuro care setting)

Habilitative (directly improve lg skills, ex sp therapy, counsel parents to help child's lg dev) Causal (focus on repairing deficits, correcting dysfunction, eliminating contributing factors) Supportive (boost lg acquisition, ex incr social contact)

Artificial Larynx/ Electrolarynx

Handheld Sound is transferred to mouth Patient articulates with exaggeration

Typical development 1-2 years

Holophrastic stage: sg-wd represents complex idea 18 mo - 200 rec wds; 50 exp wds 2 yrs begins 2wd utterances, uses 'and' as 51% nouns in vocab Overextensions (all women are mommy) Points 1-5 body parts Has presuppositions of listener Halliday functions develop 9-18 MLU: 1-2

Pons (Brainstem)

Hearing Balance V, VII

Disorders related to clefts

Hearing loss (otitis media-eustachian tube dysfunction) SSD- Diff with unvoiced, sibilants, compensatory errors, affricates, fricatives, plosives Lang: delay or related to genetic disorder Voice- nodules, hoarseness, resonance disorders

Group designs

Help establish internal validity and cause-effect Require randomization which may be hard to do Results cannot be generalized to individual clients

Genetic hypothesis

Higher familial prev in those with persistent stuttering More common in males Higher rate among monozygotic twins

Memory location

Hippocampus Pre-frontal cortex

Laryngeal cancer

Hoarse, grandual onset Swallowing difficulty Ear pain Lump in throat Ongoing sore throat

Cycles approach

Hodson and Paden (linguistic approach) Not trained to mastery, introduce correct patterns, give limited practice, move on Linguistic and motor-oriented Primarily for phonological errors and severe unintelligibility

SIGs

Hold own conferences Not all related to a specific disorder Have fees Some have Clinical Specialty Recognition, not all Clinical Specialy Recognition not required to practice

Mucosal wave action

Horizontal phase: Glottis opens back to front Folds undulate *back* to front Vertical phase: Open bottom to top Undulate *bottom* to top Surgeries to remove VF growths may affect the mucosal wave

Prognosis for speech and language based on:

How early professional help is given Quality and scope of services child receives Extent to which parents help child Presence of other conditions

People with hearing impairment manifest the following *voice*, *fluency*, and *resonance* problems:

Hypernasal on non-nasals Hyponasal on nasals Abnormal phrasing of speech Monotone Improper stress Restricted pitch High pitch Speak to fast or slow Inappropriate pauses Inefficient breathing Deviations in voice quality- Harsh/hoarse

Common medical problems African Americans

Hypertension leading to hemorrhagic strokes TBI Multi-infarct dementia Laryngeal, esophageal, lung cancer

XII - name, S, M

Hypoglossal S: none M: all of the intrinsic and the following extrinsic muscles of the tongue: styloglossus, hyoglossus, and genioglossus Damage: Tongue paralysis, diminished intelligibility, and swallowing problems

List all CN by name and most basic motor innervation for screening for function

I - Olfactory - sense of smell (S) II - Optic - vision (S) III - Occulomotor - eye movement (M) IV - Trochlear - eye movement (M) V - Trigeminal - face (S); jaw (M) VI - Abducens - eye movement (M) VII - Facial - tongue (S), face (M) VIII - Auditory -hearing and balance (S) IX - Glossopharyngeal - tongue and pharynx (gag) (S); pharynx only (M) X - Vagus - Larynx, respiratory, cardiac, and gastrointestinal systems (S & M) XI - Spinal accessory - Shoulder, arm and throat movements (M) XII - Hypoglossal - Mostly tongue movement (M)

4 Ethical principles for SLPs (PG. 602)

I: Hold welfare of persons they serve paramount (well prepared, make appropriate referrals, do not discriminate, do not guarantee effects of treatment, do not offer services solely by correspondence, obtain informed consent, evidence based treatment, maintain confidentiality) II: Maintain high level of professional competence (services offered within scope of practice, obtain continuing ed, don't allow others to perform work they shouldn't) III:Honor responsibility to public (not misrepresenting, avoid COI, make proper referrals, avoid defraud, provide accurate info, adhere to professional standards) IV:Honor responsibilities to profession (adequate supervisor responsibilities, give credits when due, professional judgment, maintain professional demeanor, uphold standards)

IMAGING

IMAGING

Iconic vs nonionic symbols

Iconic:Look like object or picture they represent Noniconic: Arbitrary/abstract, geometric

Neurophysiological hypothesis

Idea that people who stutter have abnormal neurophysicological or neuromotor organization Laryngeal dysfunction hypothesis Delayed voice onset time Incr tension in laryngeal muscles Aberrant muscle behavior Excessive laryngeal mucle activity

Neurogenic stuttering cause

Identifiable neurological event Not: emotional, social, psychological causes, or cogntive lg deficit

AAC Ax Participation Model

Identify comm needs of individual through participation inventory Assess barriers to comm by others Assess access barriers Assess client's motor, lang, literacy and other capabilitities

Syllabification

Identifying the number of syllables in a word

*Sig* symbols

Ideographic or pictographic Based on *ASL*

*PET* scan

Imaging of *metabolic activity* through measurements of *radioactivity* in the section of the body being viewed. Costs more than CAT/CT scans Info on biological processes in body

Evoked speech samples

Imitation (immediate or delayed) Naming Sentence completion

Posterior right hemisphere damage result

Impaired facial recognition

Dysphagia

Impaired swallowing

Agnosia

Impaired understanding of meaning of certain stimuli pt can see, though no sensory impairment Types: Auditory Auditory verbal Visual Tactile

Congenital Palatopharyngeal Incompetence

Impaired velopharyngeal closing-valve functioning; characterized by significant impairment of VP functions. May be caused by a short palate, occult submucous cleft, muscle insufficiency, etc. Will present with hypernasality.

Impedance vs. admittance

Impedance= resistance Admittance=counterpart of impedance; measure of energy flow

Teflon injection into vocal folds

Improve airway closure during swallowing

Tx of auditory processing disorders

Improving auditory skill Use compensatory strategies Modify environment FM system

Supramarginal gyrus

Parietal lobe, Brodmann's 40 Anterior to angular gyrus Posterior to Wernicke's Conduction aphasia, receptive aphasia Language perception and processing Agraphia

Hearing development

In utero - cochlear damage from drugs occurs in 6th-7th week (SNHL- often of the cochlea) In utero - 20wk responds to sound 3-4 mo - turns head to sound source 3 mo - responds more to mom's vc 6 mo - localizes soft speech

Achalasia

Inability for LES to relax Stays closed, prevents food from esophagus from properly entering stomach Leads to distended esophagus and acid reflux

Limitations of standardized tests

Inadequate national sampling for norms Inadequate response sampling Contrived test situations Limited participation of families in ax Inappropriate for CLD

Summarizing pt case for reimbursers

Include: Name disorder Phsyiological cause of disorder Resulting functional deficits

Comprehensive approach

Includes elements of: functional, client-specific, criterion-referenced, authentic, dynamic and porfolio ax along with traditional approach Standardized tests in limited manner

Head turn tx for voice - what purpose/disoder?

Increase glottal closure Compensatory for flaccid dysarthria Unilateral for VF paralysis

Independent vs. Relational Analysis

Independent: Child speech described without reference to adult model of language Relational: Child's speech is compared to adult model

Octave

Indication of interval between two frequencies Always maintain a ratio of 1:2 Each octave doubles a particular frequency (e.g. 200 Hz is 1 octave above 100 Hz, and 2000Hz is 1 octave above 1000 Hz)

Challenge of mechanical feeding

Infant has limited pleasurable oral experiences May refuse food

Phasic bite reflex

Infants, when gums are stimulated, will rhythmically open and close jaw and gently nibble on finger used to stimulate

Laryngitis

Inflamed, irritated larynx Voice pitch tone changes Caused by over-use, abuse Common in all ages, most common disorder Tx: meds or therapies

Extrinsic Laryngeal Muscles

Infrahyoid: Sernothyroid Sternohyoid Omohyoids Thyrohyoids Suprahyoid: Digastric Mylohyoid Geniohyoid Sylohyoid Genioglossus Hyoglossus

Tourette syndrome

Inherited Facial tics, eyeblinking Uncontrollable vocal tics

TBI communication disorders

Initial mutism Confused language Dysarthria Anomia Pragmatics (turns, initiating) Reading/writing Aud comp Abstract lang difficulties

Paralysis causes

Injury Progressive neurological disease Malignant diseases (tumors) Intubation trauma Laryngeal trauma Stroke Vagus nerve deficits

Hair cells

Inner - 1 row, most afferent, transduce mechanical sound signal to electrical via neurotransmitter synapse with nerve endings Outer - 3 rows, most efferent, amplify traveling sound wave, produce otoacoustic emissions In outer ear - capture sound waves and amplify them on way into ear

Second language learning stage terms

Interference (L1 phonology influences L2's) Fossilization (Learner's lg is set at a stage between L1 and L2) Code-switching (L1 & L2 switching in single conversation) Interlanguage (L2 has L1 features, L2 writing/speaking rules may be overgeneralized) (Not: pidginization)

Components of VF ligament (or transitions)

Intermediate and deep layers

Superior laryngeal nerve (SLN)

Internal and external branches Internal- all *sensory* info to larynx External- *motor* to solely cricothyroid

Classical conditioning

Involves unconditioned and conditioned stimuli

Paired Stimuli approach

Irwin and Weston -Highly structured and careful progression form words to sentences to conversation -Depends on identification of key word to teach correct production of target sound in other contexts -Best for children with sound distortions or a few articulation errors

Instrusive schwa

Iserting a schwa in syllable repetitions - called 'instrusive schwa' (not just 'uh', but 'bu-bu-bu-butter'; a risk factor for preschool dysfluencies to become stuttering

Deficits in language disorders in children

Limited amount of language (low overall rec and exp lang) Deficient grammar (syntax and morphology) Inadequate social communication (or inappropriate) Deficient nonverbal comm skills Deficient literacy skills (reading writing spelling) Cognitive deficits (working mem, attn, rate processing)

Structural theory of phonological development

Jakobson, Chomsky, Halle Phonological development follows innate, universal, hierarchical order of acquisition of distinctive features Assumes accurate auditory perception Child starts w maximal contrasts of /p/ and /a/, then finetunes for more contrasts Jakobson-babbling not continuous; this discontinuity hypothesis little support

PLACE-VOICING-MANNER

KNOW FOR ALL CONSONANTS REVIEW PG. 70-74 and later in quizlet

*Nasalance*

KayPENTAX sells Nasometer *Ratio of oral/nasal sound pressure in %* Pt speaks syllables/words for measurement Assessing VP function

XXXNative Language Magnet model of lang acquistiion

Kuhl -To explain why infants discriminate all phontic differences and then just own language's -'Perceptual magnet effect' facilitates native production and reduces foriegn phonetic abilities

Aphasia in Bilingual Populations

L1 may be worse, or L2 may be worse 65% recover both langs, some only one, some only the dominant Analyze individual patterns, not just known patterns

Interference or transfer

L2 directly influenced by L1

LANGUAGE AX IN ADOLESCENTS (PG.160-163)

LANGUAGE AX IN ADOLESCENTS- *confirmed*

LANGUAGE AX INFANT TODDLER SECTION (PG. 154-156)

LANGUAGE AX INFANT TODDLER SECTION- *confirmed*

LANGUAGE AX PRESCHOOL AND SCHOOL SECTION (PG. 157-159)

LANGUAGE AX PRESCHOOL AND SCHOOL SECTION *confirmed*

LANGUAGE DEVELOPMENT SECTION (pg.91-113)

LANGUAGE DEVELOPMENT SECTION- *confirmed*

Functions of language

Labeling Protesting Commenting

Language probs in autism

Lack response to speech Lack interest human voice Better response to environmental noises Fascination mechanical noises Semantics

Limitations of imitation as a target behavior

Lacks communicative intent

LLD

Langauge-based learning difficulties Phonological deficits linked to May include phonemic awareness Problems with articulation and grapheme-phoneme association

Dyslexia

Language based learning difficulty directly affecting reading Typical problems with telling time, learning words to songs, understanding questions, reading material Not: pronouncing words correctly

Preschool and school age ax guidelines

Language screening Case hx, interviews Eval sem, synt, morph, prag, rdg, wrtg, academic skills as indicated on screening Ax family culture/patterns

Thyroid cartilage

Largest laryngeal cartilage Sometimes called Adam's apple Shields other laryngeal structures from damage Composed of: Two lamina (plates of cartilage) that are joined at midline forming an angle

Adam's apple

Laryngeal prominence on thyroid cartilage Helps protect VF

Hyoid bone

Larynx is suspended from hyoid bone Many extrinsic muscles are attached

*Tardive* dyskinesia

Late-developing disorder Similar to chorea Often due to *long-term use antipsychotic drugs* *Hyperkinetic* dsyarthria Spasmodic facial movements (*tongue-protrusions aka fly-catcher movements*, grimacing, chewing, lip-smacking)

Regressive assimilation

Later occuring sound influences earlier sound Ex: guck for duck

Muscles most involved in *add*ucting the vocal folds

Lateral Cricoarytenoids (X RLN) Transverse Arytenoid (X RLN)

Fragile X syndrome

Leading inherited disabililty in men Expansion of nucleic acid cytosine-guanine-guanine (*CGG*) Large poorly formed pinna, big jaw Hyperactive, ID, echolalia, perseveration, lack of gestures, etc Avoid eye contact, limited att span

Epiglottis

Leaf-shaped cartilage attached to hyoid bone Protects trachea

Operant conditioning

Learning occuring through rewards and punishments (*consequences*)

Tx Parkinsons

Lee Silverman Voice Treatment increasing loudness helps other deficits

Muscles that adjust pitch in VF

Lengthening reduces mass, VF blown apart more readily - CT muscle (X SLN) Stiffening decreases travel time, more cycles per second - Vocalis muscle (X RLN) Both result in higher frequency/pitch

Cricothyroid

Lengthens and tenses vocal folds (X SLN- only muscle with motor innervation from SLN) Increases pitch

Mixed Transcortical Aphasia (MTA)

Lesions in watershed area of arterial borders Rare - fluent - aud comp + repeat (Impaired: Spontaneous speech, fluency, aud comp, naming, reading, reading comp, writing; *unimpaired* *automatic* *speech*)

*Ranchos* Los Amigos

Levels of responses for Assessing *Cognitive Functioning* Early: (levels 1-3) *alert*ness, *attn*, general to localize response Middle: (levels 4-5) *confused*, *agitated* to confused inappropriate agitated response Late: (levels 6-8) *confused*, *appropriate* to automatic to purposeful appropriate response

What is a specific language impairment?

Lg impairment not secondary to other impairment No known etiology Intelligence is normal Sequence of lang dev is same as typical children Various lang deficits Neural abnormalities in: frontal exec func; lang-specific areas Tx: requires continual intervention; SLI's often develop problems in middle school even after grade school improvements

Telepractic and licensing

License needed for: The state the SLP is in and (if different) The state the client is in

Palilalia

Like echolalia BUT repeat word over and over with increasing rate Parkinson's, Tourette's, and autism. With Parkinson's hypokinetic dysarthria causes eventual fade to mumble, unable to maintain phonation

Tx most neurological disorders

Like those appropriate for dysarthria Exaggerate C's, slow rate Incr mouth opening, decr posterior tongue position, improve VP closure for resonance Improve prosody Improve respiration, incr efficiency Improve VF approximation

Language Impairment: Limited linguistic exposure and environmental experience

Limited linguistic exposure and environmental experience May need: -Bilingual special education -English special education with as much primary language input/teaching as possible -Additional enrichment experiences

Typical language-learning ability: Limited linguistic exposure and environmental experience

Limited linguistic exposure and environmental experience: May need: -Bilingual education -Sheltered English -Instruction in ESL -*Additional* *enriched* *experience* (tutoring, RtI)

People with hearing impairment manifest the following *language* problems:

Limited variety of sentence types Sentences of reduced length and complexity Difficulty comprehending and producing compound/complex/embedded sentences Irrelevance of speech Limited oral comm. Difficulty understanding abstract speech Slower grammatical morpheme acquisition Omission or incorrect use of morphemes Poor reading comprehension Writing reflects oral language prob.

Anyloglossia

Lingual frenulum too short and tongue tip mobility is reduced

Phonological awareness

Literacy milestone Detect and manipulate sounds and syllables in words To be aware of sounds apart from whole words

Print knowledge

Literacy milestone Knowledge about functions and forms of written language

Ax of infants

Localization audiometry- used with older infants; head turn response Operant audiometry- conditioning voluntary response,

Granulomas

Localized inflammatory vascular lesion Granular tissue in firm rounded sac Dysphonic voice quality Often on v processes of arytenoids Can be caused by vocal abuse, intubation/GERD or contact ulcers Tx: surgery, voice therapy, or both

Place of articulation

Location of sound's production E.g. bilabial, labiodental, linguadental, lingua-alveolar, lingua palatal, lingualveolar, glottal

Bel

Logarithmic unit for intensity (sound) Decibel (dB)= measure of sound intensity= one tenth of a bel

Bel

Logarithmic unit of measure of sound intensity Decibel- Ear is sensitive to 130 units called decibels

Cog ax

Longitudinal evidence from parents, teachers, siblings, friends: Rate of learning Trajectory of learning (typical or not) Retention of learning Time needed to grasp new skills

Prader Willi syndrome

Loss function chromosome *15* *Obesity*, low muscle tone Feeding/articulation/intellectual disabilities, behavior problems

Language loss

Loss of L1 If CLD has experienced L1 loss and is acquiring English- may appear to be low functioning in both langs

Alexia

Loss of previously acquired reading skills due to brain damage Pure alexia: writing and other skills in tact Lesion of inferior cipototemporal region

Congenital HL

Loss present at birth

Agraphia

Loss/impairment of normally acquired writing skills Foot of the medial frontal gyrus (Exner's writing area)

Suprasegmentals

Loudness, pitch, rate, stress, volume, length, juncture

Fetal alcohol syndrome

Low birth weight Behavior robs Poss swallow difficulty Speech/lang probs

Fundamental frequency

Lowest frequency of a periodic wave First harmonic

MEDICALLY FRAGILE INFANTS SECTION (PG. 581-584)

MEDICALLY FRAGILE INFANTS SECTION- *confirmed*

MOTOR AND NEUROLOGICAL DISORDERS (PG. 339-369)

MOTOR AND NEUROLOGICAL DISORDERS

MULTICULTURAL SECTION (PG. 391-434)

MULTICULTURAL SECTION- *confirmed*

STRUCTURES AND PROCESSES (MOSTLY PG. 1-26)

MUSCLES SECTION- confirmed

Visi-Pitch

Machine to measure voice: Frequency range Optimal ptich Habitual pitch

MAE

Mainstream American English 10 major dialects based on geographical region

Purpose of epithelium

Maintain integrity of VF shape

Segmental Features in Phonology

Major Class Features: Consonantal - stops, fricatives, nasals, liquids (radical obstruction) Sonorant - nasals, liquids, glides, vowels, laryngeals (spontaneous voicing possible due to vocal tract configuration) - opposite of sonorant is 'obstructant' Approximate - vowels, glides, liquids (constriction but frictionless release of air) Manner features: Continuant - fricatives, rhotic, glides, vowels (not stops; airstream flows) Nasal - nasal consonants and vowels (lowered velum) Lateral - /l/ (airflow not over tongue center) Strident - /s, z, sh, zh, t/ (greater noisiness) Place features: Labial:Round - /r, w/ Coronal:Anterior - dentals, alveolars (not retroflex, palatal) and Distributed - dentals, palatal-alveolars, palatals Dorsal:Back - vowels; High -raised tongue body; Low-lowered tongue body; ATR-(short tense vowels) Pharyngeal

Internal carotid artery

Major supplier of blood to brain Splits into 3 branches: (2 major) Anterior and middle cerebral arteries, and the posterior cerebral artery

Gender voice therapy

Male to female: Counseling for emotional issues Surgery/estrogen Voice therapy for pitch and comm patterns

Mutational falsetto

Male with mature larynx has perpetually too high pitch

Digital hearing aid components

Microphone, processor (instead of amplifier; programmable), transmitter, receiver, volume/settings control Advantages: -More flexible -Digital processing helps amplify selected frequencies -More effective than analog in reducing loud noise -*Better* *signal-to-noise* ratio

Behaviorist functional units

Mands - requests (from command~demand), due to a physiological need Tacts - verbal response to objects, things, or events around us reinforced socially Echoics - imitative, other person's speech is stimulus Autoclitics - secondary; comment or clarify Intraverbals - secondary; stimulus is person's own previous verbalizations, account for fluent speech

Sternum parts

Manubrium - upper section, attachment for clavicle and first rib Corpus - body, attachment for ribs 2-7 Xiphoid process - cartilaginous lower section,

Problem with standardized tests for adolescents

Many contain sections that eval lang that develops at younger ages in typically developing children May prefer to use informal, but school might require std test

Factors related to Speech Sound Disorders (SSD)

Many institutionalized ID, otherwise intelligence not associated Gender - more boys Younger siblings vs firstborn (less likely) Low income not strong factor If SSD more likely to have language problems At risk for reading/spelling problems No strong relationship between artic and auditory discrimination problems

BICS-CALP gap

Many professionals don't know difference Unaware of diff timeline for proficiency So, many students diagnosed with disorder

Polyps

Mass growth bulging from surrounding tissue Softer than nodules May be fluid-filled, vascular tissue Tend to be unilateral Lowered pitch, voice and body fatique, pain from ear to ear Cause: Vocal abuse

Density

Mass per unit volume Density of matter serves as a medium for sound and affects its transmission

Muscles that elevate mandible

Masseter (V), temporalis (V), medial pterygoid (V), lateral pterygoid (v) Clue: Mt. Pterygoid

Language probs drugs, alcohol

Maternal alcohol during pregnancy, but also paternal FASD (fetal alcohol spectrum disorder) Leading cause ID in Western worlds Health issues: low birth weight, small hd size, CNS dysfunction, ID, delayed motor development, abnormal craniofacial, malformations major organs (heart, trachea, kidney) Other: behavior, play/social, academic (RW), artic (may have cleft), swallow, lg delay, cog, aud process, hearing FAE (fetal alcohol effects) is not FASD Motor, behavior, social, attach, cog, lang Tx: EI crucial; structure, routine; enriched environment

Fingerspelling

May be used alone or with other methods (ASL)

Submucous cleft of the soft palate

Midline deficiency or lack of muscular tissue as well as incorrect positioning of the muscles; *Usually also has a bifid uvula* present.

Deficits in Specific Language Impairment (SLI)

May have only one deficit *Articulation* and *phonological* processes (longer than typical) Less-Complex syllable structures Late starting to talk *Overextend* or *underextend* words *Word* *finding* *problems* Abstract/figurative lang is difficult *Perceptual* morphological problems *Syntactic* problems Shorter utterances Simple, declarative sentence dominate Some have *telegraphic* speech Understanding complex sentences difficult Pragmatic skills may vary Unassertive and unresponsive in communication Narratives less complete At risk for later reading/writing problems Difficulty with *order* *of* *mention* vs intention Subtle *exec/cog* *deficits*: speed, attn, working mem, emo control, task shifting, planning/organization

Phone

May or may not be a speech sound Any sound produced by the vocal tract

Sensory-Motor approach

McDonald (motor-based approach SSD) -Based on belief that the syllable is the basic unit of training AND certain phonetic contexts can be used to facilitate correct production of error sound -Does not include auditory discrimination training -Production training initiated at the syllable level 1. Heighten responsiveness to connected motor productions 2. Train correct production 3. Vary phonetic contexts 4. Generalize and facilitate transfer

Measures of central tendency

Mean- Add and divide by total Median- Exact middle Mode- Most frequent

Semantics

Meaning of lang Includes vocabulary or lexicon (e.g. antonyms/synonyms, mm words, humor, fig. lang., *deictic* words [change meaning *depending* on *speaker*]) World and word knowledge

Dyne

Measure of force in CSG system

*Dyne*

Measure of force, measured *per cm2*, used in dB SPL (sound pressure level) 1 Dyne is force needed to accelerate a mass of 1gram from 0cm/sec to 1cm/sec in one second (in SPL, air molecules are accelerated due to sound vibration) (0dB) = 0.0002 dynes/cm2 = threshold of hearing SPL is also measured in pascals

Force

Measured in Newtons (Nt) Product of mass and acceleration

Electrocochleography

Measures electrical activity of the cochlea in response to sound Measures action potential in distal CN VIII Useful in monitoring cochlear function in operating room

PH Probe/Intraluminal PH monitoring

Measures time and frequency of gasroesophogeal reflux

Electrolarynx disadvantage

Mechanical-sounding voice

Ax of Neurogenic stuttering

Medical records Ensure dx of neurological disease made Ax if pattern justifies dx Differential dx from childhood onset: min to no effects of delayed auditory feedback (DAF) and adaptation tx

Esophageal phase Tx

Medically handled, but SLP can counsel on the following: Avoid certain foods Eat small portions Lose weight Stop smoking Upright position after eating Note: These were listed in the book under direct, but most don't involve food??

Goal of feeding

Meet childs needs for healthy growth and development Avoid endangering child

Laryngeal web

Membrane growth between VF's Anterior glottal location

Hippocampus function

Memory Integrates all sensations into experience

Carcinoma and Laryngectomy

Men more than women Causes- alcohol, tobacco, exposure to environmental toxins, GERD, smokers and drinks most at risk Early signs: hoarseness, diff. swallowing, sore throat, ear pain, lump Tumors can be: Supraglottic (above VFs), glottic (VFs), subglottic (below VFs) Metastasis= spread of cancer Node involvement= important consideration

*MRI*

Method is based on alignment and realignment of nuclei of atoms in the cell when a structure is placed in a strong *magnetic* field. Functional MRI: examine brain activity while pt is engaged in task

Time delay technique

Method of predetermined waiting period Stimulus given to child Look expectantly for 15 sec If needed, prompt or model Give desired object when child initiates or responds

Contrast approach

Minimal pair- Words that only differ by one feature (phonemes may differ by only place, manner, OR voice; e.g. sea and tea); child learns semantic and motor differences between the phonemes Maximal contrast (maximal opposition)-Word pairs contain maximum numbers phonemic contrasts (differences in place, manner AND voice; e.g. top and shop)

Thrombosis vs embolism

Mneunomic: T not T *T*hrombosis - local blockage Emoblism - *T*RAVeling, gets lodged elsewhere

Vocal registers and waveforms

Modal - sinusoidal Falsetto - small amplitude Pulse - multiple peaks

Resonance

Modification of sound

Description of language disorders in adolescents Pragmatics

Modifying adding new info Maze behavior Gestures Topic maintenance Facts from opinions Difficulty with indirect phrases Relevant questions and comments Correct register

Hypothalamus function

Monitors emotion

3 months of age

More speech-like sounds if an adult responds to vocalizations

Multigroup pre-post test design

More than one experimental group

Discrete trials procedure technique

Most researched procedure Complex response broken into smaller components Useful in establishing target behaviors May not promote generalization to natural settings *Clinician* *does:* Place stimuli in front of child Ask child question Immediately model correct response, wait for child to imitate model Reinforce child for correct Give corrective feedback if incorrect Record response Wait a few seconds, initial next trial

Considerations for standardized tests

Most tests are normed on monolingual English speaking children Do not have ecological validity Translated tests are often used but pose difficulties

Upper motor neurons

Motor fibers within the central nervous system

Lower motor neurons

Motor neurons in the spinal and cranial nerves Peripheral nervous system

SSD approaches

Motor-based: Van Riper, McDonald Linguistic: Distinctive features, Contrasts, Phon Processes, Cycles Core Vocabulary: Consistency Phon Awareness

Muscles of the shoulder and arm....

Move rib cage Increase or decrease its dimensions Include *pectoralis* major, *pectoralis* minor, levator scapulae, serrates anterior

External carotid artery

Moves toward face and branches into smaller arteries Supplies muscles of mouth, forehead and face

Silent period

Much listening/comp Little expression Can last 3-6 months Believed to aid child in comprehending new language before producing it

What is AAC

Multimodal intervention using speech generating devices

Transdisciplinary

Multiple specialists collaborate on initial eval 1-2 members provide services

Interdisciplinary

Multiple specialists interact and collaborate, taking others suggestions, info and interpretations Team writes eval, reports and intervention plan

Risk of not addressing dysphagia?

Muscle damage, malnourishment, weight loss, anxiety

Language Impairment in CLD

Must be in both languages It is illegal for clinicians to place CLD students in special education to improve only english, instead, ESL

NEUROANATOMY AND NEUROPHYSIOLOGY: THE NERVOUS SYSTEM (pg. 25-56)

NEUROANATOMY AND NEUROPHYSIOLOGY: THE NERVOUS SYSTEM- *confirmed*

Deviant tongue size impacts what?

NOT: all speech sounds stridency deletion misarticulated fricatives impair vowel production DOES: have no sig impact

Tx verbal expression

Naming: many different forms Expanded utterances- systematically increasing length and complexity of target responses (e.g. reading: survival reading- extended material; writing: functional words-letters)

Stenosis

Narrow external auditory canal Cond HL

Tx of Hypernasality

Nasometer- allows for visual feedback including level of nasalance (oral-nasal ratio) and amount they are producing Visual aids Ear training Increasing mouth opening Increasing loudness Improve articulation-light articulatory contacts Decrease pitch Change rate

Medicaid caps result in:

Needed therapies often not reimbursed Increased out of pocket expenses for clients Competition among thearapy disciplines due to limited time and money alloted

Adjacency effect

New stuttering on previously fluent words surrounding previously stuttered words New stuttering may be triggered by a stimulus present when previously stuttered words were produced

Usher syndrome

Night blindness as a child

Gestural (unaided)

No instruments or aids used Pantomime Eye-blink American Indian Hand Talk (AMER-IND) ASL Limited manual sign (Limited number of gestures) Left-Hand Manual Alphabet (helpful for right side paralysis)

Manual approach for HI communication

Nonverbal Signing and fingerspelling

Hearing loss severity scale

Normal up to 15 ped/25 adult Mild - up to 40 Mod - 41 to 55 Modsev - 56 to 70 Severe - 71 to 90 Profound - above 90

Language probs low income

Not direct correlation, but if low SES, lg-learning difficulties can occur due to: health care access, low status, low educational levels of caretaker(#1), (not ethnic) Diff in: reading, writing, referencing time and temporal concepts due to lack of routine and structure in home, lack of pre-school skills (ABC's Rhyming songs, etc), delayed vocabulary, delayed morphosyntactic, overall less verbalization and less elaborate Health care factor: ill children miss school and learning ops, if sick in school diff concentrating, untreated OM, inadequate prenatal care, low birthweight

Ethical/Legal?

Not dismissing a student until end of school year even though continued tx doesn't benefit them (E, not L) SLP supervises SLP assistant and signs off on medicaid (E and L) SLP asks assistant to interpret test results and tell pt (not E)

Esophageal phase

Not under voluntary control Begins when food arrives at orfice of the esophagus Food propelled through esophagus to stomach by peristaltic action and gravity Bolus entry into esophagus= restored breathing, depressed larynx & soft palate

Artic errors Asian

Not: velar fronting; if occurs, it's artic error not dialect

Low-tech

Note pads or message boards No electronic instruments

Semantic relations in 2 word utterances

Notice - hi + noun Nomination - Demonstrative + noun; e.g. that chair Instrumental -Verb +noun; e.g. write (with) pencil Conjunction - Noun + noun; e.g. knife spoon Recurrence - More + noun; e.g.more juice Action-object - Verb + noun; e.g. pet kitty Action-ind obj - Verb + noun; e.g. give (to) mommy Agent-action - Noun + verb; doggy bark Agent-obj -Noun + noun; baby (drink) juice Possessor-possession - Noun + noun; mommy sock Attribute-entity - Adjective + noun; red ball Entity-locative - Noun + locative; juice (in) glass Action-locative - Verb + noun; jump (on) bed

Rhyme

Nucleus + Coda

Prevalence

Number of occurrences Head count at a given time Cross-sectional method

Otitis media External otitis

OM: Also, middle ear effusion; associated with upper-respiratory infections and eustachian tube dysfunction; cond HL of 20-30 dBHL (can go undetected) EO: External ear canal; swimmer's ear; cond HL

Tx tongue thrust

OMD SLP works with team: Dentist, orthodontist, physician SLP evals: swallow, rest postures, speech

OTHER AX WITH CHILDREN

OTHER AX WITH CHILDREN

Primary muscle of lips

Obicularis oris

Experimental phonetics

Objective laboratory and experimental techniques to scientifically analyze speech sounds

Cross-sectional studies

Observations of differences between subjects Goal to generalize about developmental changes as those subjects mature

Disorders of resonance Hyponasality

Obstructions in nasal cavity (adenoids, polyps, allergies) Ax subjective, can use nanometer

Cleft of palate

Of the soft palate, hard palate, or submucous)

Scanning

Offered messages sequentially until user indicates message they want

Broca's

Often damage to Broca's (area 44), but not necessarily Brodmanns 44, 45 Frontal, 3rd convolution Post inf frontal gyrus L hemi - fluent + aud comp (better than production of spoken); - read comp - repetition May exhibit apraxia of speech, right sided hemiplegia or hemiparesis, dysarthria (Nonfluent, effortful, slow; Misarticulations or distortions; Agrammatic/telegraphic,*Impaired* repetition, naming, reading and reading *comprehension*, writing)

Vocal Fold thickening

Often precursor to nodules or polyps Breathy voice, lowered pitch Anterior 2/3s VFs Cause: abuse: prolonged throat clearing, screaming, etc

Mean Fundamental Frequency

Old= lower pitch MFF of 7/8=281-297 Hz 10/11=238-270 Hz 19 female= 217 Hz 19 male= 117 Hz Adulthood: Women= 180-250 Hz Men=100-150 Hz Geriatric: Women=201 Hz Men=132-146 Hz

Language has how many 'levels'?

On some praxis practice questions, 'Levels' seems to mean 'domains' - so, 5.

Arytenoid cartilages

On supra posterior surface of cricoid cartilage on either side of midline

Complex sentence

One independent clause and one or more dependent or subordinate clause

Substantia nigra

One of four nuclei in BG Dopamine secretion Important for attention

Turner syndrome

Only in females Deformed X chromosome Swelling, webbing neck, cardiac problems, SNHL Broad chest

HIV related dementia

Onset is slow Deterioration in final stages rapid Tremors, seizors, gait probs, facial nerve paralysis, incontinence, confusion, dpression, hallucinations, delusions, mutism

Stoma

Opening in lower neck connects with trachea

Learning and conditioning theories of stuttering

Operant behavior Classically conditioned negative emotion Avoidance behavior Approach-avoidance Tension/fragmentaion reaction Demands exceeding capacities As a form of psychoneurosis

Phases of the swallow

Oral preparatory phase Oral phase Pharyngeal phase Esophageal phase

Resonant voice therapy

Organic based resonance must be first treated medically Focus: Produce voice with slightly abducted VFs and minimal subglottic pressure

OAE

Otoacoustic emission test Otoacoustics are sounds emitted by hair cells Measures function of inner ear If infant fails OAE administer ABR Useful for newborn screening

Ear parts

Outer-auricle (pinna), external meatus (canal) Middle-TM, ossicles (malleus, incus, stapes), tensor tympani and stapedius muscles, eustachian tube (connects middle ear to nasopharynx) Inner-Oval window, cochlea, semicircular canals, internal auditory meatus

Times/day ppl swallow

Over 500, less than 600

Beckwith-Wiedemann syndrome

Over-growth disorder, macrogloassia Increased risk cancer Behavior problems

Oller's infant stages: describe

P: *reflexive* sounds (cough, burp) C/G: *schwa-like*, maybe some velar consonants E: *play*/explore sound/mechanism, some CV but squeals C/R: CV strings, near adult timing, no meaning (HI fall behind) V/N: Varied CV strings

Pyramidal system vs Extrapyramidal

P: direct motor activation pathway, voluntary movement, directly signals nerve cells in spine or brainstem (fast, skilled, conscious movements) E: maintains posture and tone for voluntary movements, indirectly regulates LMN movement activity (slow, postural, reflexive movements) Damage results in involuntary and bizarre movement disorders; indirectly regulates nerve cells in spine or brainstem Both are motor pathways. E is called that to distinguish it from the pyramidal system that reaches target locations by traveling through the 'pyramids' of the medulla.

Difference periodic and aperiodic

P: symmetrical, from a tone A: asymmetrical, from noise

REVIEW VOWEL POSITION CHARACTERISTICS

PAGE 74-76 and later in quizlet

PHYSIOLOGICAL AND ACOUSTIC PHONETICS: A SPEECH SCIENCE FOUNDATION (CHAPTER 2- PG. 61-89)

PHYSIOLOGICAL AND ACOUSTIC PHONETICS: A SPEECH SCIENCE FOUNDATION- *confirmed*

REVIEW IPA SYMBOLS AND SOUNDS

Page 64 and later in quizlet

Muscle tension dysphonia

Pain in neck muscles Hoarseness VF fatigue Stroboscopic finds strong medial compression of VF and erythema but structurally normal A maladaptive behavior

XXXMuscles that retract tongue base

Palatoglossus, styloglossus Hyoglossus, transversus Upper Pharyngeal constrictor

Paraplegia Diplegia Quadriplegia Hemi*plegia* Hemi*paresis*

Para:Paralysis legs, lower trunk Diple:2 arms or 2 legs paralyzed Quardr:4 limbs paralyzed Hemiplegia:One side *paralyzed* Hemiparesis:One side *weakness*

Unilateral VF paralysis

Paralyzed fold in static position If unparalyzed fold moves pst midline may sound normal If unable to achieve closure, aphonia Tx: create bulge in paralyzed side: teflon, collogen achieve medialization: thyroplasty type I medialize/abduction: nerve-muscle pedicle reinnervation

Parallel-talk technique

Parents comment on playing with child, to expand MLU, for ex: "You are making the car go fast."

Angular gyrus

Pariental lobe (temporal edge), Brodmann's 39 Posterior to supramarginal gyrus Transcortical sensory aphasia Writing, reading, naming

Sentece classification

Passive- subject receives action (The cat was petted by Mark) Active- subject performs action Interrogatives- questions Declaratives- statements Imperatives- commands Exclamatory- express feeling

WHO levels of disability

Patholophysiology Impairment (how much person successfully performs socially defined comm activies in own natural context) Functional limitation Disability Societal limitation

Cancellation

Pausing after a stuttered word Saying it again with more relaxed stuttering

PCC severity scale

Percent Consonants Correct (Shriberg) Total number of correct consonants produced x 100/total number of consonants produced Mild >85% Mild to moderate 65-85 Mod to severe 50-65 Severe <50%

How to manage Velopharyngeal dysfunction?

Pharyngeal flap Palatal lift (flaccid) Teflon injection **

X and XI-name and function

Pharyngeal plexus Supplies the upper pharyngeal musculature including salpingopharyngeus, stylopharyngess, superior pharyngeal constrictor, middle pharyngeal constrictor inferior pharyngeal constrict, circopharyngeus, inferior pharyngeal constrictor, thyropharyngeus)

Compression (condensation)

Phase of sound with increased density of air molecules (they are compressed) Opposite of rarefraction

Oller's infant stages: name and ages

Phonation (Birth-1mo) Cooing/Gooing (2-4mo) Expansion (4-*6mo*) Canonical/Reduplicated (6-8) Variegated/Nonreduplicated (8-*12*)

Choreas characteristics

Phonetic prolongations Prolonged interruptions Variable rate syllabe production due to involuntary muscle movement

Generative theory of phonological development

Phonological descriptions are dependent on information from other linquistic levels Phonological rules map representations onto surface pronunciations Not broadly applied to SLP field

Sound

Physically: Vibration and disturbance of molecules in a medium Psychologically: Vibration or disturbance in the air that is potentially audible

Maximum phonational frequency range

Physiological limits of a person's voice, what he can generate without regard to loudness or amplitude

Tx for vocal nodules

Physiological voice therapy approaches most used Can combine hygiene (for abuse causes-rest, reduce abuse) plus efficient voice production

Cognitive theory lang acquistion

Piaget Also called Cognitive Constructionism -Children must first actively construct their own understanding of world through interactions with environment -Child must acquire concepts before the language; i.e., cognitive development precedes language -Ex: child grasps cog concept of size, then words for big, little -Language development reflects logic/reasoning development in his 4 stages

Gestural-asisted

Picsyms Pic symbols Blissymbols Sig symbols Rebuses Premack-type symbols PECS

Voice Range Profile

Plotting of range of person's fundamental frequency, measuring amplitude in db SPL (dynamic range) vs frequence in Hz (phonational range) Ie: a representation of a client's minimum and maximum intensity levels across his/her vocal range

Phonetogram displays what?

Plotting of total phonatory capabilities with regard to frequency (Hz) and intensity (dB) Graphical representation of a Voice Range Profile

Differentiating dialect from disorder: Ax tools Alternatives to standardized tests

Portfolio ax- work samples Narrative ax- story telling Dynamic ax-Ability to learn over time- test-teach-retest Lang proficiency testing (both langs)-CILF and FALF Information processing Informal ax - in natural settings RtI (response to intervention)- classroom setting Case hx

To increase a behavior, positive reinforcements that may be used are:

Positive programming Praise Modeling Shaping Self-monitoring Approval

Whisper and VF structure and function

Posterior 1/3 of glottis stays open, just the cartilaginous glottis is open The membranous glottis closes Voiced sounds: VF slap to make a buzz Unvoiced: VF kept open, free air flow

Palatopharyngeus function

Posterior faucial pillar, border oral cavity and pharynx Lowers velum, Raises larynx, (X XI)

Right hemisphere critical dx feature

Pragmatics skills more critical than awareness of illness ability

Prelingual HL vs post lingual HL

Pre-Deaf before acquire speech Post- Hearing impairment after age 5

Bones of hard palate that fuse

Premaxilla - front 4 teeth Palatine process of maxilla Palatine bone (Alveolar process of maxilla - side and back teeth - on lateral sides so not referenced in hard palate fusion)

Hard palate components

Premaxilla- front four teeth Palatine process- two pieces of bone that grow and fuse at midline Alveolar process- houses molar, bicuspid, and cuspid teeth

Palatometry

Pseudopalate fitted with electrodes to *teach people place of articulation of consonants*

Nasogastric feeding

Pt can't tolerate oral feeding Tube nose, pharynx, esophagus to stomach

Oral preparatory phase direct Tx

Press tongue on hard palate Keep food on more mobile side of mouth Apply pressure on damaged cheek Head tilt to stronger side Head forward to keep food in mouth Head back to promote swallow Bolus in anterior or middle of mouth

Temporal lobe

Primary auditory cortex (superior temporal gyrus) Auditory association area (Heschl's) Wernicke's (posterior temporal gyrus)

Brodmann's area 4

Primary motor cortex

Frontal lobe

Primary motor cortex (motor strip)- located on the precentral gyrus Supplementary motor cortex Broca's area

Occipital lobe

Primary visual cortex and association

XXXOptimality theory lang acquistion

Prince and Smolensky -Observed forms of language arise from *interaction between conflicting constrainsts* and have an input and output between the two -Constraint: structural requirement to be satisfied or violated by an output and surface form -Constraint is optimal if it incurs least serious violations -Surface forms of lg represent resolutions to underlying constraints -OT has roots in generative grammar

Mixed hearing loss

Problems in both middle and inner ear

Stroboscopy

Procedure using pulsing light to give optical illusion of slow-motion vocal fold view Based on Talbot's law - that images linger on retine for .2 seconds Can help diff functional/organic disorder or tumor

Linguavelars

Produced by back of tongue raising to contact velum /k/-voiceless, stop /g/-voiced, stop /ŋ/- voiced, nasal

Labiodentals

Produced by contact of lips and teeth /v/-voiced, fricative /f/-voiceless, fricative

Lingua-alveolars

Produced by raising tongue to make contact with alveolar ridge /t/-voiceless, stop /d/-voiced, stop /s/-voiceless, fricative /z/-voiced, fricative /n/-voiced, nasal /l/-voiced, liquid/lateral

Linguapalatal

Produced by tongue coming in contact with hard palate /ʃ/-voiceless, fricative /ʒ/-voiced, fricative /tʃ/-voiceless, affricate /dʒ/-voiced, affricate /r/- voiced, liquid /j/- voiced, glide

Linguadentals

Produced by tongue contact with upper teeth /ð/-voiced, fricative /θ/-voiceless, fricative

Bilabials

Produced by two lips /m/- voiced, nasal /b/- voiced, stop /p/- voiceless, stop /w/- voiced, glide

Articulation

Production of speech sounds Primary structures: Lips, mandible, pharynx, velum, hard palate, tongue, teeth

Approaches to Counseling

Psychodynamic - behavior is product of inner conflict (id, ego, superego) Client-centered - client need acceptence to find balance between self-concept and behavior Behavioral - focus on what can be observed Cog-Behavioral - thoughts key to feelings and actions Eclectic - combination

Gastrostomy

Pt can't tolerate oral feeding Tube abdomen to stomach

Pharyngostomy

Pt can't tolerate oral feeding Tube esophagus and stomach through pharynx

Esophagostomy

Pt can't tolerate oral feeding Tube esophagus to stomach Surgical hole in cervical esophagus

Connecting fibers in brain

Projection - cortex to subcortical (cerebellum, BG, brainstem, spinal cord) Association - connect within a hemisphere (arcuate fasciculus) Commissural - connect left and right hemispheres (corpus collosum)

Pyramidal system componenets

Projection fibers from cortex divide into: Corticobulbar tract Corticospinal tract

Reinforcement withdrawal

Prompt removal of reinforcers to decrease a response Extinction, time-out, response cost

Meninges of brain

Protective layers of the brain: Dura mater ("tough mother") - adheres to skull and to arachnoid Arachnoid ("spider web") - weblike and vascular Pia mater ("tender mother")- adheres to brain following sulci/gyri; blood enters brain through it

Benefits of standardized tests

Provide clinicians w quantitative means to compare to large groups in similar age category

*Plethysmograph*

Pulmonary plethysmographs are commonly used to *measure the functional residual capacity* (FRC) of the lungs—the volume in the lungs when the muscles of respiration are relaxed—and total lung capacity.

RESEARCH RELATED SECTION (pg. 521-551)

RESEARCH RELATED SECTION- *confirmed*

RESPIRATION SECTION (PG. 1-7)

RESPIRATION SECTION- *confirmed*

MISC CRANIOFACIAL ANOMALIES

REVIEW FOR COMPLETENESS

Regressive-Progressive mneumonic

REgressive-latER sounds influence PRogressive-PRevious sounds influence

4 Dementia therapies

RT - reminiscence therapy - discuss past events/memories, use pics, etc RO - reality orientation - remind client who what where SPT - Simulated presence therapy - play recordings of close friends/family, reducing anxiety CST - cognition stimulatin therapy - small groups, themed activities

*CAT* scan

Radiographic imaging procedure where *X-ray* beams circle through segments of the brain and pass through tissue Cost less than PET Can outline bones

Facial clefts other than prepalate and palate

Rare Lower mandibular, naso-ocular

Phonation quotient

Rate of air expelled through glottis per second during sustained phonation

Incidence

Rate of occurrence In specified group of people Longitudinal method

Speed quotient

Ratio of abductor to adductor duration in larynx

Valleculae Pyriform

Recesses, fossa, or sinuses V: one, between epiglottis and tongue P: two, either side of larynx

Morphological awareness

Recognition, understanding, use of word parts that carry significance

Sound spectrograph

Records changing intensity levels in a complex sound wave Displays a spectrogram- displays time (horizontal), intensity (darkness), and frequency (amplitude=vertical)

Semantic categories

Recurrence (more) Rejection (no) Causality (cause and effect)

General treatment goals

Reduce stuttering Establish normal-sounding fluency Reduce associated motor behaviors Reduce avoidance Counsel client and family about stuttering Counsel client and family about goals and procedures

Prolonged speech

Reduces frequency of part word repetitions and sound prologations

Medicaid pt need what to see SLP?

Referral from primary care doctor

Cerebrum

Referred to as "gray matter" Topmost portion of the brain (six layers) Four lobes in the left and four lobes in the right

Internal validity

Refers to degree that data in a study reflects a true cause-effect relationship Strong internal validity has dependent variables affected only by manipulation of indep variable

Acoustic phonetics

Relationship between articulation and acoustic signal

Voice onset time

Relative timing of stop-release and initiation of phonation

How UES opens

Relaxation cricopharyngeus muscle Hyolaryngeal extension pulls UES open Pressure of descending bolus opens UES

Components of the body

Remainder of the intermediate layer Deep layer TA muscle

Myringoplasty

Repair of ruptured TM Tx for chronic OM

Periodic waves

Repeat at regular intervals Predictable

Focused Stimulation technique

Repeated and varied modeling of target Incorrect responses are not corrected, instead model correct target

ASHA member violates code of ethics

Report to Board of Ethics NOT: Report to ASHA Inform pts Talk to member

Rebuses

Represent events/objects with words and grammatical morphemes

Intermediate response

Response that helps move toward final target in shaping procedure - part of Shaping

RTI

Response to intervention Receive small group support in the classroom before being enrolled in SE More effective than traditional std testing

Pleural linkage

Result of the pleural linings of the lungs and the thorax being stuck together, or *linked, by a vacuum *between the linings

Comprehensive and Integrated Ax

Retain some traditional ax tools (case hx, interview, lg smaple, oralmech, hrg screening) Instead of std tests, use alternative measures

Parasympathetic nervous system

Returns body to state of relaxation

Literacy skills techniques

Rhyming, Syllable awareness, phonemic isolation, sound blending

Aryepiglottic folds

Ring of connective tissue and muscle Extend from tips of arytenoids to larynx Separate laryngeal vestibule from pharynx and preserve airway

Three indicators infant/toddler may have language problems

Risk, Behavior, Late Talking Risk: established risks (congenital, genetic, autism, sensory, near, metabolic, chronic illness, severe infection, toxin) Risk: possibly at risk (low birthweight,small, withdrawing behavior, accident, OM, family hx, severe illness (mental, physical, ID) in caregiver, family dysfunction, abuse, parent below 9th grade, isolation, dangerous home, no health insurance Behavior: prelinguistic - diff eye contact, use gestures vs words, reduced babbling Late Talking: small C V inventories; less verbal; small vocab; narrative problems - sign exp lg delay

Harsh

Rough, gravely and unpleasant Excessive muscular tension and effort

Hyperkeratosis

Rough, pinkish lesion (not wart like) Abnormal *thickening* of outer layer of skin Oral cavity, larynx, pharynx

Phonology

Scientific study of sound systems and patterns Used to create sounds and words of language

Pragmatics

Rules that govern social language use Emphasis on functions Good pragmatics= good cohesion skills Narratives Direct vs. indirect speech acts

Seeing *Essential* English (SEE 1) Signing *Exact* English (SEE 2)

SEE1-ASL: words into morphemes, *written wd order* SEE2-Used more, *flexible wd order*, only breaks down morphemes into stand alone words (hot-dog)

Recruitment

SNHL issue Disproportionate perception loudness increase when sound presented in linear increases Affect hearing aid fitting

SPECIAL TOPICS SECTION (pg. 553-581)

SPECIAL TOPICS SECTION- *confirmed*

Authentic Ax

Samples sp/lg skills in everyday settings Based on concept: minimal competency core Variaton: contrastive analysis - is speech pattern part of speaker's culture or is disorder?

Microglia

Scavengers to remove dead cells and other waste in brain

Cricoid cartilage

Second-largest laryngeal cartilage Sometimes called uppermost tracheal ring Completely surrounds trachea Linked with arytenoid cartilages and thyroid cartilage

Pharyngeal flap

Secondary palatal surgical procedure in which a muscular flap is cut from the posterior pharyngeal wall, raised, and attached to the velum Openings on either side of the flap allow for nasal breathing, nasal drainage, and production of nasal sounds. Helps close the VP port and reduces hypernasality.

Direct selection

Select with touch

Types of memory

Semantic - knowledge, words, meaning Episodic - recollection specific events, etc Declarative - facts Procedural - how to do things

Deep dyslexia

Semantic deficits (degration of mem, can't derive word meaning, inabilty to convert semantic memory to phonological output) Tx: work on comprehension of word meaning and reading words out loud

Tx aud comp + naming

Semantic treatment of broad category to finer distinctions

*Tactile aids* for H

Sensory substitution method for deaf Devices or methods that promote comprehension by *converting sd to touch* Cheaper than cochlear impl Lots of practice/training required to use optimally *Tadoma* method - manual system for deaf blind, hands on speaker's face to feel vibrations and airflow

Global

Severe form of non-fluent Lesions in all language areas Perisylvian zone Also frontotemporoparietal regions - fluent - aud comp - repeat (Impaired: Language, Fluency, Repetition, naming, auditory comprehension, Reading, writing, Perseveration; Intact response to whole-body commands)

Infant readiness for oral feeding

Severity of medical condition Gestational age ( must be 35-37 weeks) Cardiovascular and respiratory stability Behavioral state organization Ability to demonstrate hunger Coordination of sucking

Reactions and Emotions

Shock/disbelief Denial Anger Grief Guilt Anxiety

XXXSilent period when adminstering pure tone test

Should be 1 minute so that if client is giving false positives, it will become apparent

Pectoralis major

Shoulder muscle Elevates sternum Increases transverse dimension of ribcage

Pectoralis minor

Shoulder muscle Increases transverse dimension of ribcage

Clavicular breathing

Shoulders elevate on inhale Strain and tension

Stridency

Shrill, unpleasant, high pitch, tinny Hypertonicity or tension of pharyngeal constructors and elevation of larynx

CILF and FALF

Similar to BICS and CALP Two types of language fluency Conversational Informal Lang Fluency Formal Academic Lang Fluency FALF takes longer than CILF

Hemangiomas

Similar to granulomas But soft, pliable, filled w blood Posterior glottal location Due to intubation/GERD, or congenital Tx: surgically excised

XXXHemiopnosia

Single sided visual neglect

ABAB design

Single-subject design A - baseline established B - treatment offered A - withdraw tx for a time B - offer tx again To show effectiveness of tx

ABA design

Single-subject design Also called Reversal procedure Compares pre-post tx Ideal ax of tx efficacy (not just research but clinically)

Multiple-baseline design

Single-subject design Alternates tx for different subjects over time, repeating baselines Shows that untreated skills don't change and only treated skills change

Descriptive phonetics

Study and explanation of unique sound properties of various dialects and languages

Dental deviation types

Skeletal malocclusion: deviations in shape and dimension of mandible and maxilla Dental malocclusion: deviations in positioning of individual teeth Class I - mostly only teeth misaligned; arches ok Class II -overjet, overbite, maxilla more forward Class III - underbite, mandible more forward

Behaviorist theory lang acquistion

Skinner -Focus on *verbal* *behavior* not all language; innateness can't be observed -Verbal behavior is taught with stimulation, response and reinforcement -This behavioral response is to events in *environment* and *social* *interactions* -Relies on classical and operant conditioning -Verbal behavior broken down into cause-effect (functional units) -Tx: Language can be taught by targeting any observable behavior and manipulating the stimuli, response and reinforcement

Children with apraxia, CAS, artic problems

Slow, prolonged sounds, repetition, cluster diff, omits, voicing errors, V/diphthong errors, metatheses, groping, prosody deviations, feeding, hypernasality, tactile aversions, delayed speech, limited phonetic inventory, inconsistant productions Ax: Dynamic Evaluation of Motor Speech Skills (DEMSS 2013) valid comprehensive for differential dx severe SSD and CAS Tx: Dynamic Temporal and Tactile Cuing (DTTC 2006) for severe CAS, intensive motor-based drill tx; target few functional words to foster neural maturation and facilitate future speech motor learning Tx: PROMPT 2010 also tactile-kinesthetic-proprioception to support and shape articulators

Corniculate cartilages

Small cone-shaped Sit on apex of arytenoids Play minor role in vocalization

Myringotomy

Small incision in tympanic membrane to relieve pressure or drain fluid Tx for acute OM

Vocal nodules

Small nodes protrude from surrounding cells Pink/reddish to white/ greyish Typically bilateral, ant 1/3 VF Hoarse, lower pitch of F0, voice and body fatique, pain from ear to ear Gradual onset Straining voice in noise situations, vocal abuse

Syllable

Smallest phonetic unit Three parts: -Onset: Initial consonant or consonant cluster -Nucleus: Vowel or diphthong in middle of syllable -Coda: Consonant end of syllable

Phonemes

Smallest units of sound that can affect meaning e.g. man and fan have different initial phonemes

Brodmann's area's 3, 1, 2

Somatosensory cortex

Tympanogram results

Sound stimulus in ear canal with air tight closure- using impedance meter Measures compliance middle ear (how well sound travels through it) Vertical: compliance, horizontal: pressure *A* - *normal* peak (*equal pressure* outer & middle ear) *B* - *flat* (fluid, *infection behind TM*, maybe TM hole) *C* - *L offset peak* (neg pressure in middle ear, eustachian tube dysfunction or *end of cold* or sinus/allergy) *As* - shallow, stiff ossicles, *otosclerosis* *Ad* - deep, *disarticulated* ossciles or scarred and thin TM

Reflection

Sound waves traveling back after hitting something

Supplemental motor area

Sound-movement sequences Damage: Apraxia

Source-filter theory

Sounds produced at the soruce of the larynx are filtered/modified by the various resonating cavities (throat, mouth, nose) Vocal tract is a 'quarter wave' resonator, if tract is 12cm then wavelength is 4x, or 48cm Formants are mathematically related: F0-1x, F1-3x, F2-5x in Hz

Esophageal speech 2 types

Speak on belches Must be wall tension Produced by PES Inhalation method: Pt keeps UES open, inhales rapidly Injection method: Pt's tongue impounds air down UES, vibrates UES

Diacritical marks or diacritics

Special symbols used in narrow phonetic transcription REVIEW ON PG. 65

Carhart notch

Specific hearing loss at 2000Hz (reduced bone-conduction sensitivity at 2000Hz) Measured by Bone-conduction testing Indicates Otosclerosis

Differential reinforcement of other behavior (DRO)

Specify one behavior that will not be reinforced (e.g. leaving chair in group therapy) Reinforce may unspecified desirable behaviors (e.g. quite sitting, coloring, reading, writing, etc.)

SRT

Speech Recognition Threshhold Level at which at least 50% of spondee words are understood

Behavioral theory of phonological development

Speech developed thru caregiver interaction No innate skills needed Not high evidence for this

XI - name, S, M

Spinal Accessory S: none M: Trapezius and sternocleidomastoid muscles; *head* *turn,* *shoulder* *shrug* Along with vagus: innervate uvula and elevator veli palatine muscles Damage: Neck weakness, inability to turn head, in ability to shrug shoulders and raise arm above shoulder

Apert syndrome

Spontaneous autosomal dominant mutations *FGR2 at 10q25-26 gene* Midfacial hypoplasia, arched grooved hard palate, fused fingers, smaller skull Articulation/hypernasality Some have normal intelligence, others mild mental retardation

Levator scapulae

Stablizes spine for shoulder elevation Elevates scapula, supports neck

Auditory phonetics

Study of hearing, perception, and brains processing

Psychoacoustics

Study of how humans respond to sound as a physical phenomenon

Natural theory of phonological development

Stampe Innate processes simplify adult form Later processes not occuring in native lg supressed, incl aud percptn Allows physiological limitations of child's speech apparatus Lang acq concepts "naturalness" and "difficulty" accounts for prevalence sounds in world languages and in child's phonetic inventories

Otospongiosis

Stapes become too soft to vibrate Requires stapedectomy

Transduction of sound vibrations (TM to CN VIII)

Stapes vibrates on oval window, perilymph vibrates, Reissner's membrane transmits these vibrations to endolymph, endolymph to basilar membrane, apex or base stimulated, hair cells's cilia move, cell tip opens (mechanical), ions enter hair cell at top, neurotransmitters leave cell at bottom, they synapse with dendrites VIII fibers (electrical)

Cover-body theory of phonation

States epithelium, superficial layer of lamina propria and much of intermediate layer of lamina propria vibrate as a 'cover' (mucosa) on the relatively stationary 'body' (vocal ligament) which is the remainder of intermediate layer plus deep layer and TA muscle

Ankylosis

Stiffening arytenoid joints May be bone-joint disease or cancer VFs won't fully close

Anyklosis

Stiffening of joints Restricted arytenoid movement

Stimulability Ax

Stimulability- ability to imitate clinician's model when given cues "Watch, listen, and say what I say"

Negative reinforcement

Strengthens or increases responses that terminate or postpone aversive events Ex: client get out of seat for long sentences; use short sentence stimuli will increase sitting, which terminates getting out of seat Another definition: Negative reinforcement occurs when something already present is removed (taken away) as a result of a behaviour and the behaviour that led to this removal will increase in the future because it created a favourable outcome **The results is always that some undesirable behavior is gone as a 'side-result' of increasing another behavior(which could be sociall acceptable or could be inappropriate)**

Causes of dysphagia

Strokes Oral/phayrngeal tumors Surgical/radiation treatment TBI Polio, pulmonary disease, cerebral palsy Genetic factors Side effects of prescription drugs

Leading cause of swallow disorders, according to National Institute of Neurological Disorders and Stroke?

Strokes, they target muscle groups in brain, and both cranial nerves or spinal nerves are involved in swallowing

Lingual frenulum

Structure at inferior portion of tongue connecting it to mandible/floor of mouth

Major categories of phonological processes

Substitutions (vocalization, gliding, fronting, stopping, palatalization, affrication, deaffrication, backing, glottal replacement) Assimilations (reduplication, regressive, progressive, voicing) Syllable structure processes (weak syll deletion, FCD, epenthesis, cluster reduction, diminutization, metathesis)

3 sub layers of the lamina propria

Superficial (Reinke's space) Intermediate Deep

Muscles that aid in pharyngeal constriction

Superior, middle and inferior constrictors, and stylopharyngeus

Brodmann's area 6

Supplementary motor cortex Sound movement sequences If damaged: Apraxia

Middle cerebral artery

Supplies entire lateral cortex and major regions of frontal lobe Damage: strokes, aphasia, reading and writing deficits, contralateral hemiplegia, impaired sensation Largest branch of internal carotid artery

Anterior cerebral artery

Supplies middle portion of parietal and frontal lobes, coropus callosum, BG Damage: cog. deficits, impaired judgement, attn, reasoning, possible paralysis feet/legs

Posterior cerebral artery

Supplies surfaces of occipital and temporal lobes Affects vision, reading, writing

Conduction aphasia

Supramarginal gyrus and arcuate fasciculus + fluent (+syntax, prosoday, articulatn) + aud comp - repetition

Thyroplasty

Surgeon creates small hole in thyroid Medializes paralyzed VF Inserts small implant to keep it medialized

Delayed hard palate closure

Surgery first to close soft palate, then later surgery to close hard palate

von Langenbeck method

Surgery to repair cleft palate by raising two *bipedicled* (attached at two ends) flaps of mucoperiosteum and bringing them together and attaching them to close the cleft.

Veau-Wardill-Kilner method

Surgery to repair cleft palate by raising two *single-based* flaps from palate, bringing together, pushed back close to cleft to *lengthen palate*, improves VP closure

Tx of cleft

Surgical management: Lip surgery- 3 months or 10 lbs Palatal surgery- 9-24 months Other Tx earlier in quizlet

Pharyngoplasty

Surgical procedure in which substances such as *Teflon*, silicone, dacron wool/silicone gel bag and cartilage may be implanted or injected into the PPW to make it bulge and thus close the VP port.

Faucial pillars composed of which muscles

Swallow response triggered at anterior faucial pillars Anterior - Palatoglossus Posterior - Palatopharyngeus Both X, XI

Swallow response triggered

Swallowing is initiated by sensory impulses transmitted as a result of stimulation of receptors on the fauces, tonsils, soft palate, base of the tongue, and posterior pharyngeal wall

EGG peaks represent:

The maximum peak of the Lx wave in electroglottography does not indicate complete glottal closure, but simply *maximal* *closure* during the adduction phase of vocal fold vibration.

Metathesis

Syllabe structure process Production of sounds in reverse order Ex: peek for keep

Diminutization

Syllable structure process Addition of /i/ to target form Ex: doggie for dog

Most dysarthrias

Symptoms: most revolve around speech (slurred, rapid, breathy, diff swallowing, general vc quality change) Tx: Speech rate reduction a significant goal

Adaptation effect

Systematic reduction in st when short passage read aloud repeatedly Most reduction by 5th read More time between readings, less adaptation No transfer to other passages Silent reading not effective

Syntactic skills Ax

T-unit: Terminable unit Independent clause and its subordinate clause(s) A unit of written language A measure of advanced syntax C-unit: Communication unit Independent clause and its subordinates but also incomplete sentences A unit of oral language A measure of oral syntax

THEORIES OF LANG SECTION (pg. 113-122)

THEORIES OF LANG SECTION- confirmed

Exec functioning/Cog processing targets

Target working mem, attn, processing speed Incr these skills also benefits langauge skills

Complexity approach

Targets first sounds that are nonstimulable, always incorrect, and later developing Underlying assumption: child will also learn simpler, earlier sounds, and force him to learn complex sounds, creating system-wide change

Task variables Performance variables

Task - clinician controlled - ex: stimuli intensity, type, etc Performance - client controlled - ex: response type, pattern, etc

Story Grammar technique

Teach and model elements of story grammar: setting, initiate event, internal response, theme, goals of charcters, attempts, direct consequences, conclusion

Auditory training for HI

Teach person w HI to listen to amplified sounds, recognize meaning, discriminate sounds, with goal of improved speech perception Nowadays instead an emphasis on modifying environment and early identification and intervention

Educator of the deaf

Teaches communication method to children with hearing impairment

Morphology ax

Tell story using morphological units, using relevant pics, ask child to retell, note use of presented morphology

Deciduous teeth

Temporary teeth appear around 6-9 mo. 20- ten in each arch

Transcortical sensory aphasia

Temporoparietal region Post middle temp gyrus + fluent - aud comp + repeat

Bloodstein

Tension and Fragmentation: Stuttering is thought to be a response of *tension and speech fragmentation*, that speech is difficult in this situation

Muscles that tense or elevate the velum

Tensor *veli* *palatini* (tenses) V Levator *veli* *palatini* (main one) X XI

Muscles that protect from excessive sound

Tensor tympani (V) - pulls malleus into middle ear reducing vibration - dampens sounds of one's own chewing - this reflex is triggered by certain levels of sound pressure Stapedius (VII) - pulls stapes away from oval window - dampens volume of one's own voice - stiffens ossicular chain, decreasing vibration energy - this reflex is the acoustic/stapedius reflex because it sends signals back to brain via VIII

Muscles that *open* Eustachian tube

Tensor veli palatini (*primary*) (V) Levator veli palatini (assists) (X XI) Both are muscles of the soft palate, pull tube open with swallowing/yawning Cleft palate impacts Tensor veli palatini function E tubes not opening means fluid in middle ear can't drain so more infections with cleft palates

Hearing Screening

Test 500, 1000, 2000, 4000 hz Often presented at 20-25 dB

Split-half reliability

Test development - correlation of responses to first half of questions to responses of second half

Dynamic Assessment

Test, teach, re-test Evals' child's ability to learn when provided instruction

Federal law mandates culturally and linguistically diverse (CLD) students

Testing and eval materials must be provided and administered in language or other mode of communication in which child is most proficient

*Alveolar pressure*

The *target pressure required for speech* in order to achieve target volume. Composed of relaxation pressure (passive forces of exhalation) and active exhalation pressure (from muscular forces).

What areas of swallowing do SLPs NOT treat?

The esophageal phase: Difficulty passing bolus through cricopharyngeal muscle Formation of diverticulum Back flow of food to larynx

Occult submucous cleft

Type of cleft that is *only detectable by x-ray* exam or nasopharyngoscopy.

Disorders of resonance Hypernasality

VP mechanism does not close nasal passage Affects fricatives, affricates, plosives; Functional or organic factors (cleft palate, submucous cleft, VPI- decreased muscle mass, adenoidectomy or tonsillectomy, paresis or paralysis) Ax can be subjective, can use nasometer

Personalization

The inappropriate assumption of responsibility for an event they did not cause. CLUE: they are *personally* the cause

X - name, S, M

Vagus nerve S: digestive system, heart, trachea, pharynx, larynx M: digestive system, heart, lungs Splits into SLN and RLN- Innervation to larynx Pharyngeal Branch: pharyngeal constrictors, muscles of the velum Damage: difficulty swallowing, paralysis of velum, voice problems if the RLN is damaged

Traditional approach

Van Riper (motor-based approach SSD) Foundation of most motor approaches to articulation therapy Also called stimulus approach Progress: isolation, syllable, word, sentence, spontaneous speech 1. Sensory-Perceptual Training (Ear Training) 2. Production Training (Sound establishment) 3. Production Training (Sound Stabilization) 4. Transfer and Carryover 5. Maintenance

Fluency stuttering method (E.g., Stuttering Modification)

Van Riper approach-modify severity and visible abnormalities is most realistic-*stutter-more-fluently* approach Goal: less abnormal stuttering Skills: -teach stuttering id'ing -desensitize client to stuttring -modify stutter'g (cancellations, pull-outs, preparatory sets) -stabilize gains -counsel client Limitation: rarely establishes normal fluency

Mand-model method technique

Variation of incidental tchg; play-oriented Ask "what do you want" Model/prompt correct response if necessary Child repeats model, if not, another prompt Child praised for imitating or responding

Allomorphs

Variations of morphemes that do not alter meaning E.g. plural -s can sound like an s or a z

Allophones

Variations of phonemes Do not change word meaning

Treacher collins

Varying facial bone underdevelopment Small jaw, *downsloping eyes*, some cleft palate Often small ears Usually hearing impairment

VPI

Velar Pharyngeal Insuffiency - structural - not enough soft palate there Velar Pharyngeal Inco*m*petence - functional - *m*uscles don't close velum sufficiently

Diagnosogenic theory of stuttering

Theory of stuttering that states parents inappropriately draw attention to child's otherwise normal disfluencies Johnson and avoidance

Core vocabulary approach

Therapy revolves around 70 core vocabulary words Twice a week, 30 mins, 8 weeks Increase intelligibility of 70 core words

Rarefraction

Thinning of air molecules Return to state of equilibrium Opposite of compression

Speech-Language Pathology Praxis Review

This study set was adapted from the user Anetz's practice set. She stated the following: "This study set has at least 500 cards gleaned from as many SLP Praxis sets available on Quizlet as of August 2016. Then I added more as I studied various practice Praxis tests. Feel free to import this set into your own account so you can change personalize it. This comes with no guarantees that it is 100% accurate! Check everything, and good luck! Btw, I did pass the praxis." As I have been studying, I have been confirming the information and insuring all information from the Advanced Review of Speech-Language Pathology Fourth Edition has been included. Subject areas that have been confirmed will include a "*confirmed*" in the subject heading.

Intrinsic Laryngeal Muscles

Thyroarytenoids Cricoarytenoids Posterior cricoarytenoids (only VF abductors) Lateral cricoarytenoids Transverse arytenoids Oblique arytenoids CLUE: all end in arytenoids

Muscles that depre*ss* the larynx (Infrahyoid muscles)

Thyrohyoid (XII,C1) , Omohyoid, Sternohyoid, Sternothyroid (three C1-3) Clue: depre*SSOT* Also assist in chewing, depress mandible in swallowing

Aerodynamic measures for respiration

Tidal volume Vital capacity Total lung capacity

Tube pt aspiration prevention

Tilt bed 30 degrees before and during continuous feeding

Pharyngeal phase direct Tx

Tilt head forward while swallowing- compensate for delayed or absent swallow reflex Switch between liquid and semisolid so liquid clears pharynx- compensate for redacted peristalsis Tilt head toward stronger side- compensate for unilateral paralysis Tilt head forward wile swallowing or place pressure on thyroid cartilage on damaged side- improve laryngeal closure

Voice onset time

Time between the release of the stop consonant and the beginning of the vowel

Cuniform cartilages

Tiny cone-shaped cartilages Under mucous membrane that covers aryepiglottic folds Very minor role in phonatory functions

Tongue part names

Tip (teeth, lips), blade (alveolar ridge), dorsum (hard palate), root (pharyngeal wall)

XXXUsage-Based theory lang acquistion

Tomasello -Children learn language from their lg experiences and structure emerges from use -'Constructions' are basic units of grammar -Emphasis on frequency (token and type) of lg input which increases experience, thereby entrenching the mental representation -Concept of 'pre-emption': rare, non-frequent lg cause child to not use in common structures

Other names for laryngeal vestibule

Ventricle of morgani Laryngeal sinus

Orofacial myofunctional disorder (OMD)

Tongue may exert some force against front teeth (tongue thrust) or push through teeth May be deviant swallow Artic errors involving /s/, /z/, /sh/... Infancy has normal tongue thrust for sucking, usually thrust decreases after infancy

Oral phase direct Tx

Tongue on alveolar ridge- initiate swallow with upward and backward tongue motion (prevent tongue thrust) Place food at back to tongue- then initiate swallow Compensate for tongue elevation problems-place food posteriorly and tilting head back Compensate for disorganized tongue movement- hold bolus against palate with tongue and use strong single posterior movement of tongue

Aphasia mini chart

Top 4: Non-fluent; Broca's, Transcortical Motor Aphasia, Mixed Transcortical Aphasia, Global Aphasia Bottom 4: Fluent; Wernicke's, Transcortical Sensory Aphasia, Conduction Aphasia, Anomic Aphasia TCM (F) and Anomia (nF) have +C +R Glob, Wernickes same except F If memorize the list of 8 in this vertical order, then memorize the V-like formation of the CCRR's for nF and F

Total lung capacity

Total volume in lungs after inhalation Equals Vital Capacity + Residual Volume

Blom-Singer TEP

Tracheoesophageal Puncture Wall between trachea and esophagus surgically punctured TEP device in stoma to keep puncture open To speak: inhale, occlude stoma, pulmonary air exhales via esophagus, UES vibrates for phonation

Acoustic immitance

Transfer of acoustic energy How much energy gets past the TM/middle ear which offer resistance (impedance) Measured by acoustic reflex threshold and *tympanograms*

V - name, S (sensory), M (motor)

Trigeminal nerve S: 3 branches: -Ophalmic:nose, eyes, forehead -Maxillary:lips, cheek, upper teeth, palate -Mandibular:jaw, lower teeth, tongue, part of cheek, part of external ear M: *Jaw* *muscles* including teproalis, lateral and medial pterygoids, master, tensor veli palatine, tensor tympani, mylohyoid, anterior belly of the digastric muscle Damage: inability to close mouth, difficulty chewing, trigemini neuralgia (sharp pain in face)

Acoustic neuroma

Tumor on acoustic nerve Causes SNHL by slowing sound impulse conduction

XXXRinne test

Tuning fork test done by physician Compares difference of time for tuning fork sound to fade when placed *two* *locations*: mastoid bone, ear canal Normal: Acond 2x Bcond CondHL: Acond > 2x SNHL: Acond < 2x

XXXWeber test

Tuning fork test done by physician Places on *middle* *of* *head* Asks where sound coming from L, R, both ears Normal: both CondHL: sound to poor ear SNHL: sound to good ear

Pragmatic ax

Turn taking Eye contact Narrative skills Topic initiation and maintenance Conversational repair

Thyroarytenoid

Two muscle masses Internal is Vocalis muscle responsible for fundamental frequency External is muscularis X RLN

Compound sentece

Two or more independent clauses joined by a comma and conjunction or semicolon No subordinate clause

Non-nutritive sucking rates

Two up and down cycles of jaw per second

Cleft of alveolar process

Unilateral, bilateral, median, submucous

Caregiver role in infant language development

Use 'motherese' ie child-directed speech: higher pitch, greater pitch fluctuations, slower rate, simpler sentences, longer pauses, referring to 'here and now' objects Games with rudimentary turn taking Follow 'line of regard' - look at and comment on what infants gazes at

Aural/oral method approach for HI communication

Use amplification for HI Verbal Auditory training Speech reading instruction

Direct laryngoscopy

Valuable if cancer is suspected and biopsy needed - Two kinds: flexible (nasal) and rigid (oral) - light at the tip of the scope; the light is fiber optic and comes from an external light source -Patient can phonate - Can be attached to a video camera (videoendoscopy), pt can view image -A stroboscopic (flashing) light source can also be used -Microphone placed at neck/thyroid to record signal - With the flexible endoscope, the specialist can view the velopharyngeal mechanism, including velopharyngeal valving. Can be lowered further to view the laryngeal mechanism. -Measures periodicity VF vibrations

Neuro-assisted (aided) AAC

Useful for profound motor impairment Electrical activity used to activate switching mechanisms Myoswitches

Total communication approach for HI communication

Uses verbal and non verbal simultaneously

CNs that exit pons

V, VII

VOICE DISORDERS SECTION (PG. 271-318)

VOICE DISORDERS SECTION- *confirmed*

VFSS

Videofluoroscopic Swallow examination Also called MBSS (modifed barium swallow study) Less invasive than FEES All stages swallow can be seen Lateral and anterior/posterior views Uses radiation Detects blockages

Endoscopy

Visual inspection of an organ Laryngoscopy inspects larynx Upper GI encoscopy inspects UES and LES Useful if biopsy of tumor/stricture needed

Vocal registers

Vocal Fry - glottal fry - pulse register - lowest pitch - creaky - waveform Modal - Chest-tone - normal vf vibration, intermediate pitch Falsetto - Head-tone - higher pitch

Voicing

Vocal fold vibration

Breathy

Vocal folds slightly open Air escapes through glottis Organic (physical) causes Nonorganic (nonphysical or functional) causes

Consonants

Voiced or voiceless Always combined with a vowel Velum elevated or lowered Vocal tract modified or constricted Airflow modified or stopped May be described by : distinctive features, place-voice-manner

Vital capacity

Volume of air patient can exhale after maximal inhale Percent VC used for: Normal conversation - 65% Classroom teaching - 80% Private conversation - 35%

Typical articulation development

Vowels before Consonants Nasal earliest Stops before fricatives Glides before fricatives Liquids later Stops/nasals before fricatives/affricates Clusters later (CC before CCC)

Syllabics

Vowels may be categorized as this

Social Interactionist theory lang acquistion

Vygotsky -Children develop language in context, not in isolation -Language exists for communication; function not structure is focus -*Lg develops thru interaction with environment and culture* which gives meaning to child's world -Parents' scaffolding contributes to LAD -Language first, then cognitive thoughts (start at age 2) Tx: build child's motivation to communicate (comm temptations)

Papilloma

Wart-like growths, pink, white or both Viral (HPV) Any point on airway Usually children Hoarse, breathy, low pitch Tx: repeated surgery, stripping mucosa (CO2 laser), plus voice therapy

Sinusoidal motion (or wave)

Wave with horizontal and vertical symmetry Contains *one* *peak* (or crest), and *one* *valley* (or trough) Contains *one* *single* *frequency* Result of a simple harmonic motion

Cerumen

Wax Produced by *hairy sweat glands and oily sebaceous glands*, which when combined with dead skin cells makes wax

Cachexia

Weight loss due to cancer complications

Fluent aphasias

Wernicke's Transcortical Sensory Aphasia Conduction Aphasia Anomic Aphasia

Line of regard

What the child is looking at Caregivers follow this- promotes language

Coarticulation

When a sound changes due to the sounds around them Allophonic variations of the same sound

Leukoplakia

White benign growth VF's or under tongue Smoking, alcohol or vocal abuse

Extinction

Withholding reinforcers to reduce a response

WRS

Word recognition score (word discrimination) How well can someone discriminate between words Pt repeats back words Presented at loud enough level to bypass HL

Description of language disorders in adolescents Semantic problems

Word retrieval Word-definition skills Word-relation problems Figurative lang Learning and using peer-group slang Abstract or mm words Precise terms with clear references (excessively use this, that, thing, stuff)

World vs word knowledge

World- autobiographical and experiential memory Word- depends on world (e.g. child who has never been to a zoo may not know zoo vocab.)

Most pharyngeal muscles are innervated by cranial nerves:

X, XI (Vagus, Spinal Accessory)

Interjudge reliability

a subject's performance same with *two* *or* *more* observers/adminstrators of tasks/tests Reliability coefficient: more similar the scores, the higher the coefficient (.9 or higher = good)

Intrajudge reliability

a subject's performance same with two or more occasions of same observer/administrator of tasks/tests *One* examiner CLUE: Intr*a*judge= *A* single judge

Tracheoesophageal fistula

abnormal opening between trachea and esophagus, primary concern is dysphagia and secondary is voice

Predictive validity

accuracy with which it predicts future performance

Distortions

air escapes from sides of mouth

Falsetto

also: Head-tone Posterior vf held tight but doesn't vibrate

Refraction

bending of sound waves due to change in speed

Primary muscle of cheeks

buccinator

Overextension

child calling all women "mommy"

Reliability

consistency or stability if something is repeatably measured Can be influenced by: Fluctuations in behavior Examiner error Instrumentation error

Concurrent validity

degree to which a new test correlates with an established test of known validity

Content validity

degree to which it measures what it states it measures systematic evaluation all test items

Construct validity

degree to which test scores are consistent with *theoretical* constructs of concepts should meet theoretical expectations of this behavior in the test subjects E.g. lang scores are higher for older children than younger children; it is known that older children have better language skills

Characteristics Spanish

dentalized t,d,n devoiced final C's Sub: b/v, ch/sh, d/th, t/th, a/ae omit plurals/possessives omit past tense adj follow nouns double negs insert schwa before /s/

Within-subjects design

dependent variables measured repeatedly in same subjects under diff conditions

Ataxic CP

disturbed balance awkward gait uncoordinated moves (Cerebellar damage)

Xerostomia

dry mouth from reduced saliva flow

ASD

estimated 1 in 68 Deficits in: social-emotional reciprocity; nonverbal comm behaviors for social interaction; relationship dev and maintenance Aspergers= ASD but high functioning (IQ above 70) Tx: Autism: behavior and social skills, systematic and prolonged lang training, poss AAC; Asperger: pragmatics

Sialorrea

excessive drooling

Inductive

experiment first, explain later (get info, then interpret that info)

Deductive

explain first, verify after (express a concept, check the facts to see if support)

Typical development 18 months

expr vocab 50 words starting to put 2 words together

Spastic CP

increased muscle tone stiff, abrupt, jerky slow movements (Motor Cortex and Direct Motor pathway damage) most common form, 61-77% all cases

Characteristics AAE

l, r lessened/omitted f,t substitued for th omit plurals/possessives 3p pres tense omit copula omit lengthened vowels before final stops

(Repeat) Hyponasality- cause and tx

lack of appropriate nasal resonance on nasal sounds Treatment: focusing, nasal-glide stimulation, visual aids

Ratio-level rating

like interval levels, but everything is related to an absolute zero (zero means there is nothing of the thing you are measuring) ex: freqency counts in stuttering

Probe

measures generalized production

CSG system

measures length (cm), time (sec), and mass (g)

Concussion

mild TBI (MTBI)

Subglottal stenosis

narrowing of subglottic space, acquired or congenital May have stridor May be caused by prolonged intubation Tx: if severe, tracheostomy

Nominal-level rating

pass/fail, male/female, categories, yes/no, never/sometimes/always, type of aphasia

Baseline

pretreatment measure

Characteristics Asian

r and l confusion devoicing omit final C's omit plurals omit copula omit past morphemes

Ordinal-level rating

rank order, concepts of greater/less than, think 2nd is greater than 1st Ranchos is this

Joint routines technique Joint reading technique

routines - freq used EI/young book - uses repetitive concepts/phrases, participatory, prosody, language structure prompts, eventually child 'reads'

Athetoid CP

slow, writhing, involuntary movements (BG and Indirect Motorpathway damage)

Voice termination time

time required to cease vocal activity

Single-subject design

to establish efficacy of treatment

Cause of apsiration in oral phase

tongue-palate seal compromised due to tongue weakness, premature spillage delayed initiation pharyngeal swallow delayed onset laryngeal closure

Efferent/afferent neurons

transmit info away from brain (motor)/bring info to brain (sensory)

Correlation coefficient

ways in which 2 variables are related

(Repeat) Hypernasality- cause and tx

when the velopharyngeal mechanism does not close the opening to the nasal passage during the production of non-nasal sounds ○ Treatment: biofeedback, visual aids, ear training, increase mouth opening, increase loudness, improve articulation, change speaking rate