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