Upgrade to remove ads
Only $2.99/month

COMD 2600 EXAM 5

Terms in this set (66)

Acquired Apraxia of Speech (AOS)
A disorder in the planning and programming of speech movements due to left frontal lobe brain damage.

- Damage occurs near Broca's area

- In most cases, occurs alongside Broca's aphasia

- Causes slow, disfluent speech and flat, monotonous intonation

- Speech sound errors:
- Based on imprecise consonants, substitute simple sounds for complex sounds

- Prosodic Impairment
- slow rate, prolonged consonants and vowels, pauses between words, even stress on syllables
Childhood Apraxia of Speech (CAS)
A severe speech disorder with words dominated by simple syllable shapes (E.g., CV CVC, VC), vowel errors, and sounds that develop early (/m/, /p/, /b/).

- Inconsistent speech sound production

- Altered intonation and word stress

- Specific area of damage not yet established

- Causes have not yet been identified; researchers disagree

- Delays in speech development, but other motor skills develop normally

- Only 1 or 2 children per 1,000
treatment methods of CAS
treatment includes:
- drill-based work on speech movements,
- phonological process remediation approaches, and
- tactile/gesture approaches

*but no approach has been demonstrated to be uniquely effective.
*treatment is for an extended period of time, frequently several years due to the severity of the disorder and lack of proven treatment techniques
Augmentative Communication
supplementing or augmenting speech using various aids
Examples:
alphabet or symbol boards
can be gestures

* Systems for speech

* Can take various forms:
- Gestures
- Communication boards
- Electronic devices

* Issues
- Motor control
- Cognitive and intellectual impairments
- is slower than oral speech

the use of an electronic communication system
congenital dysarthria
Cerebral Palsy causes _____________________________, which causes children to have speech problems because their muscles are weak or paralyzed
Respiration, phonation, resonance, and articulation
As a group, Dysarthria involves all major subcomponents of speech production:
Cerebral Palsy
- A syndrome of deficits in resulting from injury to the nervous system before, at, or shortly after birth

- The child's muscles are weak, paralyzed, and/or uncoordinated.

- Causes dysarthria in children
Causes Cerebral Palsy
Prenatal
- Anoxia (lack of Oxygen), disease, metabolic problems

Perinatal
- Anoxia from umbilical cord problems (Strangulation)
- Premature separation of the placenta
- Brain Trauma

Postnatal
- Brain trauma
One limb
Monoplegia
Both legs
Paraplegia
Three limbs
Triplegia
All four limbs (Legs and arms)
Quadriplegia
Spastic Cerebral Palsy
* Damage to pyramidal/extrapyramidal tracts

*Spasticity
- Abnormal resistance to muscle lengthening

*Muscles resist movement

*Hypertonicity
- Arms bent upward
- Legs positioned like scissors

*Muscle atrophy
Athetoid Cerebral Palsy
*Primary damage in basal ganglia (EP tract)

*Involuntary writhing and twisting movements

*Child appears to be in almost constant motion
Ataxic Cerebral Palsy
Caused by damage to the cerebellum

Disturbances in motor coordination
- Errors in the speed, direction, and accuracy of movements

Difficulty in motor tasks involving a target

Difficulty in motor tasks involving precision and rhythm
- example, playing a drum
Rigid Cerebral Palsy
Balanced hypertonicity and rigidity resulting from increased tone in muscles at both sides of joint

*Low frequency of occurrence and rarely occur alone
Tremor Cerebral Palsy
Characterized by rhythmic involuntary movements (tremors)

*Low frequency of occurrence and rarely occur alone
Levels of Severity (Cerebral Palsy)
Mild
Moderate
Severe
Mild (Level of severity for CP)
Self-help skills are adequate to care for personal needs, no significant speech problems, ambulates without appliances, not treatment necessary.
Moderate (Level of severity for CP)
Speech is impaired and special equipment may be needed for ambulation. Self-help skills are insufficient to meet daily care needs. Habilitation therapy is needed.
Severe (level of severity for CP)
Poor prognosis for developing self-help skills, ambulation, and functional speech even with treatment and the use of adaptive equipment.
Respiration (Speech and Language Development with CP)
- Reduced vital capacity, inefficient valving at the glottis/velopharynx, and within oral cavity.

- cannot generate/maintain subglottal pressure well
Phonation (Speech and Language Development with CP)
Intermittent breathiness/strangled harshness of voice; compromised by changing tonicity of vocal muslces
Resonance (Speech and Language Development with CP)
- a gradual premature opening of the soft palate during the production of syllables and a break of the velopharyngeal seal during nonnasal productions.

* These difficulties lead to hypernasality and nasal emission during speech production
Articulation (Speech and Language Development with CP)
- Mandible may be hyperextended

- Difficulties rounding or protruding mouth

- Abnormal tongue position

- All prevent precise shaping of vocal tract and lead to articulation problems
Prosody (Speech and Language Development with CP)
- Poor respiratory control => one or two utterances per breath

- Poor Laryngeal tension control => hard to manipulate changes in pitch
Speech development affected by cerebral palsy
speech sound development is delayed with the highest frequency of errors on fricatives and glides requiring tongue movement.
they make fewer errors on voiced consonants than they do on voiceless consonants

The entire speech production system is affected in many cases because of reduced respiratory support and inefficient valving of the outgoing airstream at the glottis, velopharynx, and oral cavity

The melody of speech also is affected and, in conjunction with speech sound errors, causes a reduction in speech intelligibility.
how speech samples are used for assessment of dysarthria
speech samples serve as assessment vehicles to estimate articulatory precision, speech rate, prosodic patterning, and other perceptual features. Typically the examiner collects a speech sample and listens for evidence of altered speech characteristics that are indicative of dysarthria. behaviors include slow rate, hypernasality, and harsh voice quality
Acquired Dysarthria
Occurs when an individual had developed speech and language skills before onset of the disorder
Muscle weakness, incoordination, or paralysis
Muscle dysfunctions associated with acquired dysarthria
Flaccid Dysarthria
* Caused by damage to the motor

* Muscle weakness, hypotonicity (reduced background electrical activity) and atrophy (wasting of muscles due to disuse)

* Rapid fatigue with prolonged use

* Hypernasality, nasal emission, breathiness

* May be better after rest

* Increased difficulty over time
Spastic Dysarthria
* Bilateral damage to the pyramidal and extrapyramidal tracts

*Results in hypertonicity (too much background electrical activity) and hyperreflexia (overactive reflexes)

*Articulatory imprecision, slow rate, short phrases, harsh voice quality, reduces loudness, and pitch variation
Ataxic Dysarthria
* Damage to the cerebellum
- cerebellum responsible for coordinating the direction, extent, and timing of movements

* Inaccurate and dysrhythmic movements

* Speech is monotonous

* Reflexes are normal

*Minimal weakness

*Speech intelligibility mildly affected
Hypokinetic dysarthria
* Parkinson's disease
- damage the the cells of the basal ganglia results in decrease in generation of domanine

*Hypertoned and rigid muscles

* Resting tremor that disappears with voluntary movement

* Accelerated movements and short rushes of speech

*Monopitch and reduced loudness
Hyperkinetic Dysarthria
* Damage to the basal ganglia

* Involuntary movements that may be fast or slow - superimposed on voluntary movement

* Involuntary movements may occur in one limb or the whole body

* Speech characterized by impaired prosody, articulatory imprecision, and deficits in rate of speech production, breakdowns that sound like hesitations
Mixed Dysarthria
* Disease that affect more than one part of the motor system at the same time:
- multiple sclerosis
- Amyotrophic lateral sclerosis (Lou Gehrig's disease)

* How speech production is affected depends on which systems are damaged/to what extent
Types of Acquired Dysarthria
Flaccid
Spastic
Ataxic
Hypokinetic
Hyperkinetic
Mixed
Flaccid
Disease/Disorder
* Bulbar palsy
Myasthenia gravis

Site of Lesion
Lower motor neuron

Speech Characteristics
Audible inspiration, hypernasality, nasal emission, breathiness
Spastic
Disease/Disorder
Pseudobulbar palsy

Site of Lesion
Upper motor neuron

Speech Characteristics
Ataxic
Disease/Disorder
Pseudobulbar palsy

Site of Lesion
Cerebellum

Speech Characteristics
Phoneme and syllable prolongation, slow rate, abnormal prosody
Hypokinetic
Disease/Disorder
Parkinson's Disease

Site of Lesion
Extrapyramidal system

Speech Characteristics
Monoloudness, monopitch, reduced intensity, short rushes of speech
Hyperkinetic
Disease/Disorder
Huntington's chorea
Dystonia

Site of Lesion
Extrapyramidal system

Speech Characteristics
Imprecise articulation, prolonged pauses, variable rate, impaired prosody
Mixed
Disease/Disorder
Multiple Sclerosis
Amyotrophic lateral scelrosis

Site of Lesion
Multiple motor systems

Speech Characteristics
Speech chracteristics dependent on motor systems affected
Assessment of Dysarthria
* Oral-Peripheral examination
- Structures with special attention to movement

* Frenchay dysarthria assessment
- Reflexis and volunarty movements of structures during speech and non-speech tasks

* Speech examination
- Diadochokinetics (puh-tuh-kuh)
- Speech Intelligibility Test
treatment of dysarthria
Speech therapy is often geared toward improving speech intelligibility.

With cerebral palsy treatment may initially focus on the development of a stable respiration pattern

For adults, speech intelligibility can be improved by reductions in speech rate, increases in intensity, and exaggerated articulatory movements during speech production.
Dysphagia
Difficulty in swallowing or an inability to swallow
the purposes of swallowing
nutrition and hydration and pleasure.
To remain healthy, to recover from illness or trauma, and to grow, both of these functions must be achieved in a safe and efficient manner.
stages of swallowing
Anticipatory
Oral
Pharyngeal
Esophageal
Anticipatory (Stage 1)
Happens before the food reaches the mouth

Senses "get ready" for the food: visual and olfactory info

Allows the person to discern desirable vs. undesirable foods
BOLUS
The sticky ball of food that has been chewed and mixed with saliva
Oral (Stage 2)
Voluntary

Two Parts:
1.) Preparatory
*Lips are sealed
*Larynx/pharynx at rest
*Mastication in a rotary lateral manner
*Sensory input about food: taste, texture, temperature, bolus size
*Back of the tongue is elevated to keep the bolus in the oral cavity

2.) Transport
*Tongue pushes bolus up against the palate and back toward the pharynx
*Size and consistency of bolus dictate lingual strength needed
*Once it passes the anterior faucial arches and enters the pharyngeal area, this stage is over...
Pharyngeal (Stage 3)
* Largely involuntary
* Two objectives
1.) Protect the airway
2.) Direct bolus to the
stomach

*Sensory information is sent from the mouth and oropharynx to the medulla (part of the brainstem)
- Brainstem and sensorimotor cortex crucial

*The medulla houses the cranial nuclei of the cranial nerves that control the motor movements of the larynx, pharynx, and tongue

Lots of things all at once!!
* Velum elevates and
contracts
* Larynx closes (hold
your breath!)
* Hyoid and larynx move
up and forward
* Epiglottis covers larynx

Pharyngeal muscles move in a wave-like fashion (peristalsis) to push bolus down
*Superior, medial and
inferior pharyngeal
muscles contract

UPPER ESOPHAGEAL SPHINCTER OPENS
The great scope of practice wall
CAUTION !!!
No SLP assesses or treats beyond this point!!!!
Stage 3
Esophageal (Stage 4)
You may now breathe again
*Larynx lowers and
opens

Upper esophageal sphincter contracts

Bolus moves through esophagus in peristaltic waves

This is voluntary
Aspiration
Happens to healthy swallowers occasionally

It it happens all the time, thats when the trouble starts

Happens when food enters the airway

Characterized by:
*coughing
*choking
*fevers
*pneumonia

A.K.A.

Oops! It went down the wrong tube!
dysphagia treatment plan
Positioning
Environmental modifications
Adaptive feeding equipment
Bolus modifications
Swallowing techniques
Positioning (Aspect of a treatment plan for Dysphagia)
What is the best position for the patient while eating?

Does the patient need any special head or neck support?

How long should the patient remain upright after eating?
Environmental modifications (Aspect of a treatment plan for Dysphagia)
Does the patient need a quiet room to eat in?

What kind of reminders or cues does the patient need to put the food in his or her mouth and remember to chew and swallow?
Adaptive feeding equipment (Aspect of a treatment plan for Dysphagia)
Does the patient need a nonslip bowl, a spoon with a special handle, or a cup with a spout?
Bolus modifications (Aspect of a treatment plan for Dysphagia)
What consistancy of food is easiest and safest for the patient to eat?

Is it thin or thickened liquids or finely chopped or pudding-like food?

Does the patient do better with hot or cold foods?

How much food should be given for each swallow?
Swallowing techniques (Aspect of a treatment plan for Dysphagia)
Can the patient be taught any compensatory strategies to avoid aspiration?

Does the patient need instructions for safe swallowing, such as multiple swallows for each bolus or alternating liquid and solid foods?

Can the patient's swallow be imporved through the use of touch or cold?

Does the application of ice and pressure to the anterior faucial pillars improve a swallow that is delayed?

Are there interventions that can make a permanent change in the swallow over the course of time?

Will facial exercises, vocal adduction exercises, breathing exercises, or pharyngeal strengthening exercises improve the dysphagia?

Are there sensory stimulation procedures, such as the use of cold or touch, that will help to facilitate a swallow?

Will any rehabilitation maneuver that aids in directing bolus flow or increasing laryngeal elevation be of benifit?
how dysarthria is associated with children
cerebral palsy
how dysarthria is associated with adults
cerebrovascular or progressive neurological disease

The neuromuscular problems that underlie dysarthria cause difficulties in swallowing as well as in speech
determines severity of dysphagia
modified barium swallow (MBS)

Procedure is a fluoroscopic image that is recorded on videotape. The SLP and the radiologist perform this procedure together.

endoscopy
(FEES)

in the SLP scope of practice

a flexible scope is inserted through the nose and positioned just above the epiglottis. Then patient then is given food mixed with dye. As the patient eats, the examiner observes the pharyngeal structures and functions through the scope.
etiologies of dysphagia in children
the two most common are:
Prematurity
Cerebral Palsy
SLP's role on a dysphagia team
They've been trained to understand the structure and function of the oral mechanism, pharynx, and larynx and to apply this knowledge to the assessment and treatment of speech disorders. These same structures are an important part of the swallowing process; thus, it is more efficient to have one professional managing these overlapping areas.
YOU MIGHT ALSO LIKE...