question

Sternocledomastoid

answer

Muscle of respiration

question

Muscle which opposes velopharyngeal closure

answer

Lavator veli palatini

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Major acoustic characteristic of voiceless fricatives

answer

aperiodicity

question

Front vowels characterized by

answer

High frequency second formant (F2)

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Technique which results in temporary facilitation of swallow reflex

answer

Thermal stimulation

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Stroboscopy

answer

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

question

Bulbar palsy characterized by

answer

Flaccid paralysis

question

Independent variable

answer

manipulated to determine its effect on the dependent variable

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Within-subjects design

answer

dependent variables are measured repeatedly in the same subjects under different tasks/conditions

question

between-subjects design

answer

each participant participates in one and only one group. The results from each group are then compared to each other to examine differences, and thus, effect of the IV. For example, in a study examining the effect of Bayer aspirin vs Tylenol on headaches, we can have 2 groups (those getting Bayer and those getting Tylenol). Participants get either Bayer OR Tylenol, but they do NOT get both

question

Multiple baseline design

answer

The multiple baseline design allows for evaluation across clients, situations, or problems. It is a true experimental design in that it allows for causal inference. It is extremely useful for evaluating situations where an intervention would be likely to bring about enduring changes in the dependent variable

question

Flaccid paralysis of soft palate remediated by

answer

palatal lift appliance to compensation for intact but non-functioning palate

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1st choice of tx for submucous cleft

answer

surgery

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1st choce for congenitally short palate

answer

surgery

question

Best way to assess swallow (prior to providing speech tx)

answer

modified barium swallow

question

ellipses

answer

omission of words or other linguistic units b/c they're unnecessary or contextually inferfed.

question

deixis

answer

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

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Leading causes of aphasia

answer

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

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Fluent aphasias

answer

Wernicke's, conduction, transcortical sensory, anomic

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Anomic aphasia (location)

answer

tempo-parietal, angular gyrus; second temporal gyrus

question

Anomic aphasia (characteristics)

answer

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

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Conduction aphasia (location)

answer

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

question

Characteristics of conduction aphasia

answer

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

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Transcortical sensory aphasia location

answer

Posterior parieto-temporal, sparing Wernicke's area

question

Transcortical sensory aphasia characteristics

answer

Fluent. Intact repetition, poor auditory comp, paraphasias

question

Wernicke's aphasia location

answer

Posterior third of superior temporal gyrus

question

Wernicke's aphasia characteristics

answer

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

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Nonfluent aphasias

answer

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

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Global aphasia (common location of lesion)

answer

Left MCA (entire perisylvian region)

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Global aphasia (characteristics)

answer

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

question

Transcortical motor aphasia location

answer

frontal lobe; anterior and superior to Broca's area

question

Characteristics of transcortical motor aphasia

answer

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

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Broca's aphasia location

answer

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

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Broca's aphasia characteristics

answer

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

question

Standardized aphasia tests

answer

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

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Functional aphasia assessment tools

answer

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

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Prognosis for tx of aphasia is better in patients who are:

answer

younger & healthier; better educated & in verbally demanding occupations; whose lesions are smaller; who have no othermedical or behavioral disorders; who have good hearing acuity; who have less severe aphasia; whose tx is initiated soon after onset; whose family members are `involved

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Incidence

answer

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

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Commissural fibers

answer

Facilitates communication btw rt and lft hemispheres by connecting cortical areas of the 2 hemispheres

question

Norm-referenced standardized assessments allow...

answer

comparisons of individual performance on a test w/ that of a defined group

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Reliability

answer

Results are replicable. If a test is reliable, it yields consistent results. Reliability is a prerequisite for measurement validity

question

Split-half reliability

answer

Test's internal consistency. Scores from one half of the test should correlate with results from the other half the two halves give the same results

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Parallel-forms reliability

answer

Administering parallel forms of the test to the same group of people.

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Test-retest reliability

answer

Test's stability over time. Administer the same test multiple times to the same group and the scores should be similar

question

Rater reliability

answer

Level of agreement among individuals rating a test. Intra-rater and Inter-rater

question

Intra-rater reliability

answer

Results are consistent with the same person rating the test more than once

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Inter-rater reliability

answer

Results are consistent with more than one person rating the test.

question

Validity

answer

A test is valid when it measures what it's supposed to

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Face validity

answer

It appears to measure what it's supposed to measure

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Content validity

answer

Tests contents are representative of the skill being assessed

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Construct validity

answer

Test measures theoretical construct which explains the behavior

question

criterion validity

answer

Use external criteria- concurrent or predictive validity

question

Concurrent validity

answer

Test's validity in comparison to a widely accepted standard

question

Predictive validity

answer

Test's ability to predict performance (ex: GRE)

question

CNs involved in swallowing

answer

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

question

Stages of normal swallow

answer

Oral preparatory phase, oral phase, pharyngeal phase, esophageal phase

question

Describe oral preparatory phase of swallow (adults)

answer

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

question

Describe oral phase of swallow

answer

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

question

Describe pharyngeal phase of swallow

answer

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

question

Esophageal phase

answer

Bolus is transported through the esophagus into the stomach

question

Neurological causes associated w/ dysphagia

answer

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

question

Non-neurologic causes associated w/ dysphagia

answer

Head and neck cancer, GERD, esophageal tumors

question

Diagnostic tests for dysphagia

answer

Videofluoroscopy, fiber-optic endoscopy, scintigraphy

question

Videofluoroscopy

answer

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

question

Fiber-optic endoscopy

answer

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

question

Scintigraphy

answer

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

question

Laryngeal penetration

answer

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

question

Aspiration

answer

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

question

Tx for dysphagia

answer

Lip exercises, tongue exercises, jaw exercises, swallowing exercises

question

Postural tx methods for dysphagia

answer

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

question

Chin tuck

answer

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

question

Head turn (to weak side)

answer

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

question

Head tilt (to stronger side)

answer

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

question

Head back posture

answer

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

question

Chin tuck w/ head turn

answer

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

question

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

answer

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

question

Supraglottic swallow

answer

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

question

Super-supraglottic swallow

answer

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

question

Mendelsohn Maneuver

answer

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

question

Effortful swallow

answer

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

question

Shaker Exercise & Mendelsohn exercise

answer

Rehab swallowing exercises to improve function of strap muscles

question

Gastrostomy

answer

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

question

Odynophagia

answer

pain during swallow

question

Surgical/medical tx to protect airway

answer

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

question

Surgical treatments to improve glottal closure

answer

Medialization thyroplasty and injection of biomaterials

question

Medialization thryoplasty

answer

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

question

Surgical/medical tx to improve opening of pharyngoesophageal segment

answer

Dilatation, Myotomy, Botox Injection

question

Bedside swallow exam

answer

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

question

Blom-Singer

answer

indwelling low-pressure voice prosthesis kit (laryngectomy)

question

ProVox

answer

low-resistance indwelling prosthetic (laryngectomy)

question

Servox

answer

transcervical electrolarynx

question

Cooper-Rand

answer

intraoral electrolarynx

question

HME device

answer

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

question

7 Extrinsic muscles of larynx

answer

Digastric,Stylohyoid, Mylohyoid, Geniohyoid,Hypoglossus, Genioglossus, Thropharyngeus

question

7 Intrinsic muscle of larynx

answer

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

question

Muscle with greatest control of fundamental frequency

answer

Cricothyroid

question

Muscle of abduction

answer

Posterior cricoarytenoid

question

Muscles of adduction

answer

Lateral cricoarytenoid, transverse arytenoid

question

Spastic dysphonia

answer

overadduction of VFs = strained, choked, or creaky voice

question

Functional dysphonia

answer

Likely results in no voice due to underadducted VFs.

question

Vocal cord paralysis-vocal characteristics

answer

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

question

Ventricular dysphonia

answer

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

question

Laryngeal web

answer

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

question

Acute laryngitis

answer

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

question

Vocal nodules characteristics

answer

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

question

Ventricular phonation

answer

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

question

Spastic dysphonia

answer

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

question

Contact ulcers

answer

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

question

Glottal fry

answer

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

question

Reflexive vocalizations

answer

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

question

Cooing

answer

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

question

Babbling

answer

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

question

Canonical babbling

answer

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

question

Jargon/1st words

answer

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

question

Piagetian theory

answer

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

question

Piaget's stages

answer

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

question

Information-processing theory

answer

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

question

Social learning theory

answer

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

question

Nativist theories

answer

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

question

Behavioral theories

answer

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

question

Empiricist theories

answer

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

question

Emergentist theories

answer

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

question

/p, m, h, w/ typically mastered

answer

by age 3

question

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

answer

by age 4

question

/d/ typically mastered

answer

by age 5

question

/l/ typically mastered

answer

by age 6

question

/s, z, v/, "ch", "sh", "j", voiceless "th", and "zuh" typically mastered

answer

by age 7

question

sounds mastered latest

answer

/r/ sounds and voiced "th"

question

Parents bring their 4-year-old daughter in for SLP evaluations. They are concerned about /r/ sound production and periods of stuttering for the last 18 months. SLP observes that child exhibits sound-syllable repetitions on 30 percent of words. Best action for SLP to take?

answer

Provide stuttering intervention but no articulation intervention for /r/ at the present time because /r/ typically isn't mastered until after age 7

question

Brown's stage I

answer

Age: 1:0-2:2 yrs MLU: 1.0-2.0

question

Brown's stage II

answer

Age: 2:3-2:6 yrs MLU: 2.0-2.5

question

Brown's stage III

answer

Age: 2:7-2:10 yrs MLU: 2.5-3.0

question

Brown's stage IV

answer

Age: 2:11-3:4 yrs MLU: 3.0-3.75

question

Brown's stage V

answer

Age: 3:5-3:10 yrs MLU: 3.75-4.5

question

Stage II- Brown's grammatical morphemes

answer

Age: 2:3-2:6 yrs Morphemes: Present progressive -ing Prepositions in & on Plural -s Irregular past tense verbs (e.g. I ran)

question

Stage III- Brown's grammatical morphemes

answer

Age: 2:7-2:10 yrs Morphemes: Possessive -'s Uncontractible copula be (e.g. He was sad).

question

Stage III-IV Brown's grammatical morphemes

answer

Age: 2:7-3:4 yrs Morphemes: Articles a, the, an

question

Stage V Brown's grammatical morphemes

answer

Age: 3:5-3:10 yrs Morphemes: Regular past tense -ed Regular 3rd person singular -s (e.g. daddy drives fast). Irregular 3rd person singular (e.g. We did it). Uncontractible auxiliary (e.g. Mommy was sleeping). Contractible copula be (e.g. She's funny. They are funny) Contractible auxiliary (e.g. He's eating. They are eating). *auxiliaries (e.g. will, have, must, would)

question

Operant conditioning

answer

form of learning in which an individual's behavior is modified by its consequences; the behavior may change in form, frequency, or strength

question

Classical conditioning

answer

form of learning in which one stimulus, the conditioned stimulus or CS, comes to signal the occurrence of a second stimulus, the unconditioned stimulus or US

question

Waveform

answer

graph of the amplitude of particle movement (vertical axis) as a function of time (horizontal axis)

question

Source-filter theory

answer

Energy from a sound source is modified by the resonating system (a filter) to yield the acoustic signal of speech. From vowels, the energy source is usually VF vibration and resonating system in vocal tract

question

Harmonic

answer

a whole-number multiple of a fundamental component. For human voice, fundamental component is fundamental frequency of vocal cord vibration (125 Hz for men and 225 Hz for women).

question

Formant

answer

vowels are associated w/ high-energy dark bands that run horizontally. These bands are resonances of the vocal tract called formants

question

whispered speech

answer

aperiodic

question

T/F consonants have formants

answer

False, because they are not periodic (i.e. they are aperodic)

question

Spectrogram

answer

a graphic or photographic representation of a spectrum. 3-D analysis printed on 2-D surface. Horizontal dimension = time; vertical dimension = frequency; darkness = intensity. Each vertical line on a spectrogram represents a vocal fold pulse (single vibration)vowels vary widely in direction

question

Velopharyngeal insufficiency

answer

VP insufficiency occurs due to an anatomical or structural defect. This is most commonly associated with cleft palate. The primary effects of the VP insufficiency are air-flow escape and hypernasality. Secondary effects are disorders in speech articulation (distortions, substitutions and omissions)

question

Major factor underlying speech impairment in persons w/ cleft palate

answer

Palatopharyngeal insufficiency

question

Velopharyngeal incompetence

answer

VP incompetence describes dysfunction of an anatomically intact VP mechanism as in patients with neuromuscular disorders. VP incompetence is traditionally managed by a palatal lift prosthesis.

question

Palatal lift

answer

appropriate when the VPI is caused by poor movement of the velum. The anterior, retaining portion clasps to the teeth and a posterior tailpiece pushes the soft palate up into position to obturate the nasopharynx

question

Obturator

answer

appropriate when the VPI is caused by a deficiency in the length of the soft palate to close the velopharyngeal port.

question

Pharyngeal flap

answer

raises a vertical flap of tissue from the posterior pharyngeal wall. The flap is pulled across the nasopharynx and sutured into the velum. This leaves two openings on either side of the flap that are closed during speech by the inward movement of the lateral pharyngeal walls

question

Instruments used to assess velopharyngeal function

answer

Flexible endoscopy, Videofluoroscopy Cephalometric radiography

question

Tx approaches for remediation of speech resonance disorders

answer

Surgery such as a pharyngeal flap or sphincter pharyngoplasty, may be recommended to correct moderate to severe velopharyngeal dysfunction. Speech therapy is a great tool for children who have speech errors and may be an effective treatment option for mild resonance disorders. The goal of therapy is to help a child learn to use his/her tongue, lips, and velopharyngeal valve correctly

question

8-yr-old with repaired palatal cleft has received speech intervention for 2 years to reduce moderately severe hypernasality and nasal emission. Cognitive and linguistic skills are normal. Data supports that abnormal speech characteristics are result of inadequate velopharyngeal mechanism. There have been small improvements, but none in past 6 - 9 months. Which of following is most appropriate course of action for SLP to take at this point

answer

Refer child to cleft palate tame for consideration of surgical or prosthetic management

question

2 months after undergoing surgery to improve velopharyngeal function, a client continues to exhibit nasal airflow and articulatory compensations in production of pressure consonants. The SLP would most appropriately

answer

provide speech treatment

question

8-yr-old with moderately severe hypernasality has persistent nasal regurgitation following and adenoidectomy performed 6-months earlier. Child's speech is likely to show greatest improvement

answer

with pharyngeal flap surgery

question

Substitutions most likely to occur in conjunction with hyponasality

answer

/b/ for /m/

question

Dysarthria

answer

Neurologically based speech disorder. Many different types. Common to all: impaired muscular control of the speech mechanism and peripheral or central nervous system pathology

question

Communication problems in dysarthria include

answer

respiratory, articulatory, phonatory, resonatory, and prosodic disturbances caused by weakness, incoordination, or paralysis of speech musculature

question

Ataxic dysarthria

answer

Results from damage to cerebellar system. Characterized predominantly by articulatory & prosodic problems

question

Ataxic dyarthria physical characteristics

answer

gait disturbances, over- or undershooting of targets; uncoordinated, jerky, inaccurate, slow, imprecise movemnts

question

Ataxic dysarthria communication characteristics

answer

Artic: imprecise consonants; irregular artic. breakdowns & vowel distortions Prosody: excessive & even stress; prolonged phonemes and intervals btw words or syllables; slow rate of speech. Phonatory: monopitch, monoloudness, and harshness Speech quality: drunken sounding

question

Neuropathology of ataxia

answer

cerebellar lesions, Friedrich's ataxia, TBI, alcohol and drug abuse, meningitis and encephalitis (inflammatory conditions)

question

Flaccid dysarthria

answer

LMN damage. Results from damage to motor units of cranial or spinal nerves that supply speech muscles

question

Flaccid dysarthria neuropathology

answer

myasthenia gravis; vascular diseases & brainstem strokes; infections (e.g. polio and AIDS); dymyelinating disease (e.g. Guillain-Barre syndrome); progressive bulbar palsy & ALS (degenerative diseases); surgical trauma during brain, laryngeal, facial, or chest surgery

question

Specific CNs which may be involved in flaccid dysarthria

answer

trigeminal (V), facial (VII), glossopharyngeal (IX), vagus (X), and hypoglossal (XII) nerves

question

Physical characteristics of flaccid dysarthria

answer

weakness, hypotonia, atrophy, diminished reflexes; twitches of resting muscles (fasciculations) and contractions of individual muscles (fibrillations); rapid and progressive weakness w/ use and recovery with rest

question

Communication characteristics of flaccid dysarthria

answer

Respiration: weakness in combination w/ cranial nerve weakness; Phonatory: breathy voice, audible inspiration, short phrases; Resonance: hypernasality, imprecise consonants, nasal emission, short phrases; Phonatory-prosodic: harsh voice, monopitch, and monoloud

question

Hyperkinetic dysarthria

answer

Results from damage to basal ganglia (extrapyramidal system). Associated w/ involuntary movements and variable muscle tone. Prosodic disturbances are dominant

question

Causes of Hyperkinetic dysarthria

answer

etiology often unknown; include vascular, traumatic, infectious , neoplastic, and metabolic factors; Huntington's disease

question

Physical characteristics of hyperkinetic dysarthria

answer

abnormal & involuntary movements of orofacial muscles; myclonus (involuntary jerks), tics of face and shoulders, tremor, chorea; abrupt & severe contractions of the extremities; writhing, involuntary movements (athetosis); spasms; dystonia (contractions of antagonistic muscles); spasmodic torticollis; blepharospasm

question

Communication characteristics of hyperkinetic dysarthria

answer

depends on dominant neurological condition (e.g. chorea, dystonia, athetosis, etc.) Phonatory: voice tremor, intermittently strained voice, voice stoppage, vocal noise, harsh voice Resonance: predominantly intermittent hypernasality Prosody: slower rate, excess loudness variations, prolonged intervals within words, equal stress Respiratory: audible inspiration and forced and sudden inspiration or expiration Artic: inconsistent problems, including imprecise consonant productions and distortions of vowels

question

Hypokinetic dysarthria

answer

Results from damage to basal ganglia (extrapyramidal system)

question

Causes of hypokinetic dysarthria

answer

Parkinson's, Alzheimer's, multiple or bilateral strokes, repeated head trauma, inflammation, tumor, antipsychotic or neuroleptic drug toxicity, hydrocephalus

question

Physical characteristics of hypokinetic dysarthria

answer

Resting tremors of face, mouth, and limb muscles which DIMINISH when moved voluntarily; mask-like face w infrequent blinking and no smiling; micrographia (small writing); walking disorders (slow to start, then short, rapid, shuffling steps); postural problems such as involuntary flexion of head, trunk, arm, and difficulty chanting positions; decreased swallowing (drooling)

question

Communication characteristics of hypokinetic dysarthria:

answer

Phonatory: monopitch, low pitch, monoloudness, harsh and continuously breathy voice Prosody: reduced stress, inappropriate silent intervals, short rushes of speech, variable and increased rate in segments, short phrases Artic: imprecise consonants, repeated phonemes, resonance disorders and mild hypernasality Respiratory: reduced vital capacity, irregular breathing, faster rate of respiration

question

Spastic dysarthria

answer

Results from bilateral damage to upper motor neurons. Lesions in multiple areas, including cortical areas, basal ganglia, internal capsule, pons, and medulla are common

question

Physical characteristics of spastic dysarthria

answer

spasticity and weakness, especially bilateral facial weakness, though jaw strength may be normal and lower face weakness may be less severe; reduced range and slowness of movement, loss of fine and skilled movement and increased muscle tone; hyperactive gag reflex; hyperadduction of VFs and inadequate velopharyngeal port closure

question

Communications characteristics of spastic dysarthria

answer

Prosody: excess & equal stress, slow rate, monopitch, monoloudness, reduced stress, and short phrases Artic: imprecise consonants & distorted vowels Phonatory: continuous breathy voice, harshness, low pitch, pitch breaks, STRAINED-STRANGLED quality, short phrases, slow rate Resonance: predominant hypernasality

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Mixed dysarthrias

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Combination of two or more pure dysarthrias. Most common mixed types are: flaccid-spastic and ataxic-spastic

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Mixed flaccid-spastic

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associated with ALS

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Characteristics of mixed flaccid-spastic

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imprecise consonants, hypernasality, harsh voice, slow rate, monopitch, short phrases, distorted vowels, low pitch, monoloudness, excess & equal stress and reduced stress, strained-strangled quality, breathiness, etc

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Mixed ataxic-spastic

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associated with MS

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Characteristics of mixed ataxic-spastic

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impaired loudness control, harsh voice quality, imprecise articulation, impaired emphasis, hypernasality, inappropriate pitch levels, and sudden artic breakdowns

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Unilateral Upper Motor Neuron Dysarthria

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Result from damage to upper motor neurons that supply cranial and spinal nerves involved in speech production

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Causes of UUMN dysarthria

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vascular disorders produce lft-hemisphere lesions may coexist w/ aphasia or apraxia; dysarthria due to rt-hemisphere lesions may coexist with rt hemisphere syndrome

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Physical characteristics of UUMN dysarthria

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unilateral lower face weakness, unilateral tongue weakness, unilateral palatal weakness, and hemiplegia/hemiparesis

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Communication characteristics of UUMN dysarthria

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Artic: imprecise consonants and irregular artic breakdowns Phonatory: harsh voice, reduced loudness, strained harshness Prosody: slow rate, increased rate in segments, excess and equal stress, monopitch, monoloudness, low pitch, and short phrases Resonance: predominantly hypernasality Other: dysphagia, aphasia, apraxia, and rt hemisphere syndrome

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Assessment of dysarthria

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1) Record extended conversational speech and reading sample; 2) Use variety of speech tasks (e.g. imitations of syllables, words, phrases, and sentences), sustained vowel prolongation; 3) Diadochokinetic rate or alternating motion rations and sequential motion rates; 4) Assess speech production mech during nonspeech activities (e.g. oral mech exam, coughing, nasal airflow); 5) Assess respiration, phonation, articulation, prosody, and resonance, and intelligibility; 6) Standardized tests (e.g. Assessment of Intelligibility of Dysarthric Speakers & Frenchay Dysarthria Assessment)

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Treatment of dysarthrias

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techniques to modify respiratory, phonatory, articulatory, and resonatory problems are all necessary

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Tx goals in dysarthria

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modification of respiratory, phonatory, articulatory, resonatory, and prosodic problems and increasing the efficiency, effectiveness, and naturalness of communication; increase physiological support and teach self-monitoring skills

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Tx procedures

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Intensive, systematic, and extensive drill, instruction, demonstration, modeling, shaping, prompting, fading, differential reinforcement, and other proven behavioral management procedures. When necessary, phonetic placement and instrumental feedback or biofeedback may be used

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Dementia is associated with

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Wernicke-Korsakoff syndrome (associated with alcoholism), Alzheimer type, frontotemporal dementia, Parkinson's, Huntington's infection, and other (vascular disease, multiple CVAs, TBI)

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Rt hemisphere syndrome

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Symptoms: attentional and affective symptoms; communication deficits found in 50% of cases. Treatment often addresses problems such as impaired attention, impulsive behavior, pragmatic communication impairments and visual neglect

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Tx of patients with TBI

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Cognitive rehabilitation and direct communication training`

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Cognitive rehab following TBI

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Clinicians may train the following: attention, visual processing, and memory

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Communication Tx following TBI

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Involves direct behavioral procedures. Systematic reinforcement of attending behaviors, appropriate discourse, topic maintenance, self-correction, etc. to decrease inappropriate behaviors. Goals should be functional w/ initial focus on effectiveness of communication NOT grammatical correctness. Family members should be involved.

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Apraxia is often associated with lesions in what area?

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Broca's

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Porch Index of Communicative Ability

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Samples speech & language skills to only a limited extent

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Apraxia of speech (AOS)

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Neurogenic speech disorder. A basic disorder of volitional movement in the absence of muscle weakness, paralysis or fatigue.

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Locus of AOS

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caused by damage or injury to speech-motor programming areas (e.g. Broca's) in the dominant hemisphere

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T/F patients with AOS have rapid rate of speech?

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False. They typically have a reduced rate

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Characteristics of AOS

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Consonants more impacted than vowels; increased frequency of errors on longer words; groping behaviors; automatic productions easier than volitional productions; awareness of errors; speech sound substitutions common, particularly substitution of voiceless phoneme for voiced (e.g. "pet" for "bet"); may make several unsuccessful attempts to self-correct

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Assessing AOS

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Repetitive production of single- and multiple syllables (e.g. "puh-ta-kuh", multisyllabic words); imitative production of progressively longer words, phrases, and sentences; picture description tasks; assess oral reading; assess overall movement of limbs; administer standardized tests (e.g. Apraxia Battery for Adults)

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Tx of AOS

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Auditory-visual stimulation, oral-motor repetition, & phonetic placement

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Progression of Tx of AOS

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Carefully sequenced to move from automatic simple productions to less automatic, more spontaneous productions

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