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Organic Communication Dis. Exam 1
Terms in this set (136)
the exchange of information between two or more persons
Non-verbal communication includes?
gestures, facial expressions, postures, and sounds
Verbal communication includes?
anything word based so speech, ASL, and writing.
the abstract, rule-based, symbol system used for human communication
Language may be expressed in which ways?
speech, writing, and signs
Where does language formulation occur?
In the brain of the speaker
Where does language understanding occur?
in the brain of the receiver
oral expression of language using the vocal tract of a speaker and hearing mechanism of the listener
physical production of the separate speech sounds
phonation or the sound produced by vibrating vocal folds
What are the three characteristics of voice and what they mean?
Pitch - highness or lowness in voice
Loudness - intensity
Quality - clarity of voice
White noise contains what frequency ranges?
near infinite # of frequencies
Vocal ____ is based on the spectrum and periodicity of the sound being produced.
changes in the voice due to differences in the vocal tract configuration (damping and amplifying, modification)
What are two critical areas of speech we assess in all clients, immediately?
Intelligibility (scale) and Naturalness [AKA Usualness (subjective).
the smooth production of on-going speech
Define: speech rate
speed of ongoing speech
Define: speech rhythm
pattern of ongoing speech
changes in duration, inflection, intonation (stress or emphasis)
What gives speech meaning?
What type of speech sound is among the most periodic?
Define: communication disorder
a condition or state that interferes with the exchange of information between one person (the speaker) and another (the listeners). It may involve the formulation, production, reception, or decoding of the information.
What is the criteria of a communication disorder?
A person may be said to have a communication disorder if it interferes with communication, because they cannot be understood, draws attention to itself, or causes the user to be maladjusted.
The cause or origin of a disease, it may be organic or functional.
Provide some examples of an organic etiology.
CVA, Cerebral Palsy, Cleft Palate, Voice, Hearing Loss, ALS, Parkinson's
Provide some examples of a functional etiology.
Articulation, stuttering, voice, child language, behavioral issues, faulty learning, malingering: usually related to educational, social, or psychological factors.
What are the possible times of onset?
Congenital (or present at birth) or acquired (anytime after birth)
What is the degree and pattern of the problem?
Degree: normal (0), mild (1), moderate (2), severe (3)
Pattern: deteriorating, improving, variable (exacerbating-remitting)
List the different types of communication disorders
Language, Speech (articulation, voice, resonance, fluency, suprasegmentals), & Swallowing
non-medical professionals trained at the master's or doctoral level, certified to practice by ASHA, licensed in most states and credentialed to work in schools. SLPs work in public schools, clinics, hospitals, agencies, universities, and private practices
What do SLPs do?
trained to evaluate and treat adults and children with communication disorders including, speech, language, voice, fluency, hearing, and swallowing problems.
Treatment for communication disorders may include?
habilitation, rehabilitation, AAC, & education/counseling for family/clients
providing communication skills for persons who have never had them
treatment for persons who have lost communication skills
What are the structures and functions of the nervous system related to speech?
brain, brain stem, spinal cord, peripheral nerves (cranial & spinal nerves)
formulate, initiate, control, adjust, decode speech
What are the structures and functions of the respiratory system for speech?
vocal tract, thoracic cavity (lungs, ribs, diaphragm, abdominal muscles)
control of inhalation and exhalation (power force for speech)
What are the structures and functions of the phonatory system for speech?
larynx (cartilage and muscle, mucosa, vocal folds)
voice production (phonation)
What are the structures and function of the articulatory system?
lips, teeth, alveolar ridge, tongue, hard/soft palate, velum, vocal folds (voicing)
Production of phonemes (speech sounds)
What are the structures and functions of the resonance system for speech?
pharynx, oral cavity, nasal cavity, tongue, velum, jaw, lips
Amplification and modification of sound
What are the structures and functions of the auditory system?
outer, middle, inner ear; acoustic nerve
reception and transmission of sound
List the steps for vocal hygiene.
Don't smoke; don't talk in noise; drink 6 8oz glasses of water per day; do a vocal warm-up; limit caffeine; avoid eating within two hours of going to bed; limit talking with cold, flu, or upper respiratory infection
steadily getting worse
loss of voice, especially due to an organic or functional disturbance of the vocal organs
examination of the interior canal or hollow organ by means of an endoscope. A medical instrument used for visual examination of the interior of a body cavity a hollow organ. It can be both rigid or flexible tube with lenses, a fiber-optic light source, (and/or a probe, forceps, or suction device).
a wound or an injury; a localized pathological change in bodily organ or tissue.
the removal and examination of a sample of tissue from a living body for diagnostic purposes
Act of producing sound
the study of the distribution and patterning of speech sounds in a language and rules governing pronunciation
the quality or condition of being understood
an interruption in the smooth flow of speech (fluency), as by a pause or the repetition of a word or syllable.
To disintegrate or wear away, become worse or inferior in character, quality and value
to become better
to change periodically or in succession, differ or alternate
Paralysis on one side of the body
amyotrophic lateral sclerosis
a degenerative motor neuron disease leading to death usually within 2 years
In what ways can an SLP help aid in medical diagnoses?
What we diagnose will help the physician, we do finer movement/process testing and we can actually help identify cranial nerve lesions
What are the steps involved in the diagnosis of a person suspected with dysarthria?
Identify the system affected, Establish a clinical profile (differential diagnoses), Establish baselines (intelligibility, stimulability- ability to change behavior through probing), Determine unexploited abilities, Focus therapy goals (most effective, easiest, client wants), Determine prognosis
What systems do apraxia usually affect vs. dysarthria?
apraxia: articulatory system; dysarthria: resp, phon, resonance, artic
What are some key points in determining intelligibility in dysarthria ?
Make sure to measure at different times of the day and week, use other listeners to write down what they hear, When is the affected person best?
presenting an easier model to see if the client is able to produce a target or a close approximation of the target.
Define: unexploited abilities
things a person can do to help themselves that they typically don't use.
The focus of therapy should ask: what are the three questions to answer whether behavioral change will be maximally effective with a particular Tx. approach?
What will result in the biggest communication change?
What is going to be the easiest one for them to do, what are they already successful at? What does the client really want to change-motivation is key?
any loss or abnormality of psychological, physiological, or anatomical structure or function
any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being
a disadvantage for a given individual that limits or prevents the fulfillment of a role that is normal
Provide a definition of impairment, disability, and handicap to a layperson.
a problem with a structure or organ of the body, disability is a functional limitation with regard to a particular activity, handicap refers to a disadvantage in filling a role in life relative to a peer group
David is a 4yr.old who has a form of cerebral palsy (CP) called spastic diplegia. David's CP causes his legs to be stiff, tight, and difficult to move. He cannot stand or walk. What are his impairments, disabilities, and handicaps?
Impairment: The inability to move the legs easily at the joints and inability to bear weight on the feet is
an impairment. Without orthotics and surgery to release abnormally contracted muscles, David's level
of impairment may increase as imbalanced muscle contraction over a period of time can cause hip
dislocation and deformed bone growth. No treatment may be currently available to lessen David's
Disability: David's inability to walk is a disability. His level of disability can be improved with physical
therapy and special equipment. For example, if he learns to use a walker, with braces, his level of
disability will improve considerably.
Handicap: David's cerebral palsy is handicapping to the extent that it prevents him from fulfilling a
normal role at home, in preschool, and in the community. His level of handicap has been only very mild in the early years as he has been wellsupported
to be able to play with other children, interact normally
with family members and participate fully in family and community activities. As he gets older, his handicap will increase where certain sports and physical activities are considered "normal" activities for children of the same age. He has little handicap in his preschool classroom, though he needs some
assistance to move about the classroom and from one activity to another outside the classroom.
Appropriate services and equipment can reduce the extent to which cerebral palsy prevents David from
fulfilling a normal role in the home, school and community as he grows.
Cindy is an 8 year old who has extreme difficulty with reading (severe dyslexia). She has good vision and hearing and scores well on tests of intelligence. She went to an excellent preschool and several different special reading programs have been tried since early in kindergarten. What are her impairments, disabilities and handicaps?
Impairment: While no brain injury or malformation has been identified, some impairment is presumed to
exist in how Cindy's brain puts together visual and auditory information. The impairment may be
inability to associate sounds with symbols, for example.
Disability: In Cindy's case, the inability to read is a disability. The disability can probably be improved
by trying different teaching methods and using those that seem most effective with Cindy. If the
impairment can be explained, it may be possible to dramatically improve the disability by using a method
of teaching that does not require skills that are impaired (That is, if the difficulty involves learning sounds for letters, a sight reading approach can improve her level of disability).
Handicap: Cindy already experiences a handicap as compared with other children in her class at school, and she may fail third grade. Her condition will become more handicapping as she gets older if an effective approach is not found to improve her reading or to teach her to compensate for her reading difficulties. Even if the level of disability stays severe (that is, she never learns to read well), this will be less handicapping if she learns to tape lectures and "read" books on audiotapes. Using such approaches, even in elementary school, can prevent her reading disability from interfering with her
progress in other academic areas (increasing her handicap)
Is normal speech usually a realistic goal with patients who have dysarthria?
It depends, but largely not in dysarthria.
Dysarthria therapy goals must be related/relevant to ___, ___, ___, and ___.
course, medical treatments, severity, and handicap
What are 8 specific treatment options for dysarthria
1.) supplement speech with AAC
2.) reduce the impairment by improving function (drills, exercise)
3.) behavioral compensation: rate, control, shorten breath groups
4.) prosthetic compensation: mechanical or electrical aid to speech
5.) eliminate maladaptive behaviors - efforts which don't enhance speech
6.) Interaction enhancement - what can we offer to listeners to help them adapt to a client's speech (Communication Breakdown Resolution)
7.) Communication Skills Maintenance - continued practice for 10 minutes on selected activites
8.) Reducing the handicap by (a) reducing the impairment or (b) changing the attitudes of listeners
(R BICEPS R)
What are the four major considerations when evaluating a treatment plan:
it should take into consideration the client's communication needs, preparation for the future, minimal intervention, and involve the principles of motor learning (massed practice and knowing of results)
What are some different types of general respiratory changes you could make with a patient suffering from dysarthria?
increase respiratory support, adjust respiratory pattern, increase respiratory flexibility
What do laryngeal-focused treatments generally target in dysarthric patients?
aphonia, increased loudness, improved vocal quality, improved laryngeal co-ordination
What are some general treatment targets for velopharyngeal dysfunction in dyarthric patients?
behavioral changes, prosthetics (i.e. palatal lift), surgery
True or false, in patients with dysarthria, oral articulation problems are often treated in isolation from other treatment concerns.
False, seldom treated in isolation
Articulation impairment can be impaired by other factors: ____ and ____.
increased rate and failure to show voicing contrasts
What are the two treatment categories of articulatory characteristics?
Normalizing function - attempts to reduce problem through training
Compensating for the Impairment -
What are two types of normalizing function treatments available to dysarthric patients?
reducing abnormal muscle tone (such as spasms through relaxation) and strengthening
Relaxation of muscle groups may include specific muscle groups like the ____ and ____ or may involve generalized relaxation like ______.
lips, face, frontalis
When would exercising/strengthening be contraindicated in dysarthria?
When a client is suffering from myasthenia gravis - the more action the muscles get, the weaker they get
Exercises for oral articulation in dysarthria include:
use of assistive force; movement against resistance; bilabial closure, rounding, and retraction; tongue protrusion, retraction, and elevation
True or false, oral motor exercises in articulation and phonological disorders are indicated.
False, only in motor speech disorders, specifically dysarthria.
What are 3 therapy options when compensating for impairment?
altering usual articulation to achieve acceptable productions, contrastive production & intelligibility drills, and prosthetics
Intelligibility drilling are useful because they can _____ and _____.
be easily adjusted for difficulty and can aid in developing communication breakdown resolution strategies
What are some types of prosthetic compensation devices for dysarthria Tx?
palatal lifts, bite blocks (stabilize), rate reduction devices (pacing, delayed aud. feedback)
a collection of symptoms
Define: cerebral palsy
a syndrome which includes deficits in visual, auditory, intellectual, and motor functions resulting from injury to the CNS either before, at the time of, or shortly after birth
True or false, cerebral palsy affects both the CNS and PNS of patients with equal incidence rates.
False, CNS only affected in cerebral palsy
True or false, cerebral palsy often results in dysarthria
What is the incidence of CP?
What is the etiology of cerebral palsy?
damage to CNS or failure of CNS to develop
What is a likely cause of cerebral palsy before birth?
toxins, viruses, hemorrhage
What is a likely cause of cerebral palsy during birth?
trauma during delivery, asphyxia, premature birth
What is asphyxia?
lack of oxygen
What is a likely cause of cerebral palsy during the first three years of life?
Rh incompatibility, encephalitis, accidents (damage to the CNS)
What is the course of cerebral palsy?
unchanging to possibly improving. Physical status usually remains unchanged, but may actually improve with the maturation of the nervous system.
How do physical impairments in cerebral palsy adversely affect speech and language?
physical movement and environmental exploration are critical parts of speech and language development, they cannot be as easily learned if there is limited movement
What are other disorders related to cerebral palsy?
other sensory impairments, hearing impairments, intellectual impairments, cognitive deficits
What are the four major types of cerebral palsy?
spacticity, athetosis, ataxia, and mixed
tightness caused by simultaneous contraction of both agonist and antagonist muscle pairs.
How is speech affected by spacticity?
respiratory difficulties and voice breaks affect prosody (suprasegmentals, rhythm, rate); also severely affects articulation
involuntary contraction, with flailing of extremities and facial grimaces.
How is speech affected by athetosis? (seen in CP)
Poor respiratory control, voice is monotone, with many artic distortions
lack of balance and coordination
How is speech affected by ataxia?
The severity of symptoms in cerebral palsy range from ___ to ___.
very mild to very severe
What is the greatest problem associated with cerebral palsy?
Developmental delays, Motor impairment (severely limits development including walking and most daily-life activities ). Difficulty sitting erect. Swallowing may be impaired, these pre-speech tasks may limit speech development
What is the role of the SLP in cerebral palsy?
Dx. of communication related deficits, Tx may work on pre-speech activities and then using whatever compensatory strategies are available
True or false, is not advised in cerebral palsy.
Define: cleft lip and palate
a congenital opening on one or both sides of the lip, an opening in the palate, an inadequacy of the velopharyngeal mechanism or a combination of these
What is the severity of cleft lip and palate?
varies from mild to very severe
True or false, dental, facial, and skeletal abnormalities are seldom present with a cleft lip or palate.
What is the etiology of cleft lip and palate?
results from an interruption in normal facial development due to multiple factors including genetic predispositions in association with other factors such as infections, diseases, drugs, nutrition, environmental chemicals (Know as multi-factorial inheritance)
When does facial development of an embryo occur?
56 days (8 weeks)
The palate forms in an embryo from the closure of the ___ and the _____
medial and lateral palatine processes
What is the incidence of cleft palate? In what populations is it higher?
1/750; Indians-highest, African Americans-lowest
What medical treatments are needed for cleft palate in addition to the surgical correction?
ENT to treat frequent conductive hearing loss
Orthodontia and Prosthodontia to correct dental and palatal abnormalities
What types of speech defects occur with cleft palate?
phonological and articulatory deficits; velopharygeal dysfunction causing hypernasality and inability to produce pressure consonants
What is the role of the SLP in cleft lip and palate care
serves as a team member in ongoing evals of communication problems, provided speech therapy as needed primarily for articulation and phonological problems, and possibly for any related language deficits
a loss (due to brain damage) in the ability to encode or decode the syntactic, semantic, phonologic, or pragmatic aspects of language. Disproportionate to any cognitive deficit, it may express itself in oral/aural and/or written/reading modes.
a MOTOR-SPEECH disorder due to PARALYSIS or paresis of speech musculature (respiratory, phonatory, articulatory, resonance). May result in distortions and quality impairments related to damage of lower motor centers of the brain. Usually mild in aphasic patients. (Always Affects motor functions)
an inability to produce voluntary speech movement in the presence of normal muscle function. May also reflect in other motor acts, non-voluntary acts seem normal. Typically affects articulation, but may also alter rhythm and rate. (planning of speech, sequencing)
Dysarthria: Age of Onset
congenital (CP, facial paralysis) or acquired (CVA, TBI)
vascular, traumatic, infectious, neoplastic, metabolic, toxins
developmental, recovering, stable, degenerative, exacerbating-remitting
Dysarthria: Site of Lesion
CNS or PNS or both. The lower the lesion site in the NS, the more severe the dysarthria. (lower motor (pns)=flaccid always)
Dysarthria: Neurological Diagnosis
CP, MS, ALS, CVA, Parkinson's
one or a combination of: spasticity (CNS-contractions of agonist & antagonist), flaccidity (PNS), ataxia (CNS-intoxicated), tremor, dysmetria (mvnt measurement difficulty)
Dysarthria: Speech Components
respiratory, phonatory, velopharyngeal (resonance), and articulatory (lips, tongue, jaw)
Dysarthria: Perceptual Characteristics
imprecise consonants, nasal resonance imbalance, voice disorders (pitch, loudness, quality), rhythm & rate
ranges from very mild to no functional speech
Craniofacial Anomaly Management-Medical Team consists of:
Pediatrician (while important to overall care not usually the most important member of the Cleft team)
PLASTIC SURGEON (probably the most important member of the cleft palate team, often serves as coordinator)
Otolaryngologist -ENT (after the Plastic Surgeon probably the most important medical member of the team, providing care for hearing loss issues)
Craniofacial Anomaly Management-Non-Medical Specialists consist of:
Speech pathologist (Probably the most important non-medical member of the team)
Genetics Counselor (predict outcome of child)
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